Medical outcomes after canal wall-down mastoidectomy, external ear canal reconstruction, tympanoplasty, and mastoid obliteration for extensive cholesteatoma

Abstract

Objective: To report medical outcomes and time-related recidivism after extensive cholesteatoma treated with canal wall-down (CWD) mastoidectomy, external ear canal (EEC) reconstruction, tympanoplasty, and S53P4 bioactive-glass mastoid obliteration. Methods: Retrospective study of 127 ears with extensive cholesteatoma treated at a tertiary center. Patients were scheduled for annual otoscopic and non-echo-planar DW MRI follow-up for up to 4 years. For each postoperative year, only ears attending that visit and all previous yearly visits were analyzed. Main outcomes were: completely epithelialized, dry ear; tympanic membrane and/or posterior–superior EEC retraction; retraction pocket (RP) cholesteatoma; and residual cholesteatoma on MRI. Results: Follow-up attendance declined from 100% (127/127) in year 1 to 67.2% (41/61) in year 4. A dry, epithelialized ear was achieved in 96.9% (123/127). Retraction developed in 33.9% (43/127), with probabilities of 13.4%, 26.4%, 28.9%, and 34.1% at 1, 2, 3, and 4 years, respectively. RP cholesteatoma occurred in 11.8% (15/127) and residual cholesteatoma on MRI in 7.0% (9/127); 23% of retracted ears progressed to RP cholesteatoma. Children ≤ 11 years had higher rates of retraction and RP cholesteatoma. Conclusions: Despite counseling on the importance of follow-up, attendance declined over time. CWD mastoidectomy with EEC reconstruction, tympanoplasty, and S53P4 obliteration yielded high long-term dry ear rates in extensive and recurrent cholesteatoma, but complete eradication was not achieved. Younger and re-operated patients were at higher risk of retraction and RP cholesteatoma. Recidivism appeared years after the first surgery, supporting prolonged follow-up. Reporting annual outcome incidence in future studies would enhance understanding of extensive cholesteatoma.