Clinical evaluation of cholesteatoma in cases with either type III or IV tympanoplasty

Abstract

A retrospective analysis of 38 cholesteatomas operated by either type III (23 cases) or IV (15 cases) tympanoplasty is reported. The follow up periods were ranged from 7 months to 4.7 years and a mean period was 2.1 years. Canal wall down and complete mastoidectomy followed by meatal reconstruction and mastoid obliteration in one stage was performed if cholesteatoma expanded in and around the stapes. We evaluated postoperative hearing level according to the guideline of the Organizing Committee of Otology Japan (1987) in this study. Thirteen cases (72.2%) with primary operation with type III tympanoplasty improved in hearing level. From the technical point of view, a ossicular reconstruction with a cortical bone (60.6%) or residual ossicle (62.5%) was successful compared to a cartilage columella.(20.0%) Three patients were required surgical revision because of otorrhea or attic retraction, but residual cholesteatoma was observed in two cases.
In conclusion, we propose that canal wall down technique and complete removal of cholesteatoma followed by meatal reconstruction using cortical bone and mastoid obliteration with bone chips are mandatory, if cholesteatoma is invaded in and around the stapes.