Abstract
Recurrence of middle ear cholesteatoma due to a retraction pocket is one of the postoperative problems. Preserved canal wall mastoidectomy has a higher risk of recurrent cholesteatoma than the removed canal wall approach. However, removed canal wall mastoidectomy predisposes the risk of postoperative cavity complications. Therefore, a surgical method for recurrent cholesteatoma has not been established. We analyzed the clinical features of 39 ears with recurrent cholesteatoma that underwent unplanned revision surgery between January 2017 and December 2020. The period from the previous surgery to the unplanned revision surgery was less than 5 years for 17.9% (7/39 ears) and more than 5 years for 82.1% (32/39 ears). In the previous surgery, canal wall preserved mastoidectomy with scutum removal (M1a/b + M2a) was performed in 84.6% (33/39 ears), and mastoidectomy with whole canal wall removed (M2c) was performed in only 15.4% (6/39 ears). The site of recurrence in the M1a/b + M2a group was the attic in 51.3% (20/33 ears), pars tensa in 18.2% (6/33 ears), and both the attic and pars tensa in 21.2% (7/33 ears). The posterior canal wall preservation rate of the M1a/b + M2a group was 42.1% (8/19 ears) in poor mastoid cell development cases and 64.2% (9/14 ears) in good mastoid cell development cases. The posterior canal wall of poor mastoid cell development cases tended to be difficult to preserve in unplanned revision surgery. Patients with a preserved posterior canal wall did not require any postoperative care, though it is necessary to pay attention to possible recurrence in the future. It is important to flexibly select the mastoidectomy approach in case of unplanned revision surgery for recurrent cholesteatoma considering the balance between curability and quality of life.
