title: The learning curve in revision cholesteatoma surgery.
abstract: OBJECTIVE
  To review the results of revision surgery for cholesteatoma.
  
  
  METHODS
  Retrospective review of patient's records.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990-2002 was performed. A total of 758 patients were divided into two groups according to surgical experience, and followed during short-term and long-term period. The cholesteatoma was divided according to location, age of patients, status of auditory ossicles, and bilaterality of disease.
  
  
  METHODS
  The patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. The indications for the reoperations were: recurrent or residual cholesteatoma, resuppuration, and AB gap more than 20 dB.
  
  
  METHODS
  Type of surgical therapy, localization of cholesteatoma, age of patients, revisions, bilaterality of disease, damage of auditory ossicles and learning curve were analyzed.
  
  
  RESULTS
  The number of revision operations was reduced in the second period (from totally 24.3% to 16.4%). Closed technique gave a significantly lower rate of failure. For attic cholesteatoma, adults, bilateral disease, and ossicular damage the rate of revisions was significantly lower with surgical experience.
  
  
  CONCLUSIONS
  Surgical experience was important for reduction of reoperation rate for attic and sinus cholesteatoma, adults, bilateral cholesteatoma, and when closed technique is used.
authors.affiliation: Clinic for Otorhinolaryngology, University Clinical Center Nis, Serbia. milanorlstankovic@gmail.com
authors.forename: Milan
authors.initials: M
authors.lastname: Stankovic
mesh_terms: D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000503:physiopathology / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008297:Male; D013506:Otologic Surgical Procedures / Q000193:education* / Q000379:methods; D012086:Reoperation / Q000193:education; D012189:Retrospective Studies; D055815:Young Adult