Between January 1990 and September 1999, 125 cases with middle ear cholesteatoma were operated in Mie University Hospital. Ninety-three cases (74.4%) were operated on by canal wall down tympanoplasty with canal reconstruction, 17 cases by canal wall down tympanoplasty, 13 cases by canal wall up tympanoplasty, and 2 cases by radical mastoidectomy. For the canal reconstruction, cortical bone was used for attic reconstruction in 59 cases, and auricular cartilage was used in 30 cases. Postoperative attic retraction was found in 40 of 59 cases (67.8%) with cortical bone reconstruction and 15 cases developed retraction cholesteatoma. In 32 of 40 cases (80%), attic retraction was found within 1 year after the surgery, and all retraction cholesteatoma occurred within 5 years. Attic retraction was not found in 28 of 30 cases (93.3%) with auricular cartilage reconstruction, and recurrent cholesteatoma did not occur. Revision tympanoplasty was performed in 14 of 19 cases with recurrent cholesteatoma: seven cases by auricular cartilage reconstruction, four cases by cortical bone reconstruction, and three cases by radical mastoidectomy. Attic retraction was not found after the revision surgery with auricular cartilage reconstruction, while all four cases with cortical bone reconstruction developed attic retraction again. Auricular cartilage is useful for attic reconstruction to prevent retraction cholesteatoma.
