title: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes.
abstract: OBJECTIVE
  To review long-term hearing results after intact canal wall mastoidectomy with tympanoplasty for treatment of cholesteatoma and to identify factors associated with improved hearing outcomes.
  
  
  METHODS
  A retrospective analysis of all cases of cholesteatoma treated with intact canal wall mastoidectomy at a single institution by the senior author over a period of 9 years, for which at least 2 years of follow-up data exist.
  
  
  METHODS
  Patient and disease information was collected retrospectively and analyzed.
  
  
  RESULTS
  There were 148 patients with 156 affected ears treated and followed for a median of 5.3 years (interquartile range, 3.6-7.4 years). The majority of the operations (144/156, 92%) were staged. Hearing data were available for 150 ears. The overall postoperative mean air-bone gap was ≤ 20 dB in 64% of patients. This was maintained long term in most patients, with 59% of patients still with an air-bone gap ≤ 20 dB at a median follow-up of 5.3 years. The presence of an intact stapes did not affect initial hearing outcomes, but the group with an intact stapes had improved long-term hearing results compared to those without an intact stapes (71% vs. 42% air-bone gap ≤ 20 dB, P < .001). The presence of a malleus handle also led to superior long-term hearing outcomes (72% vs. 48% air-bone gap ≤ 20 dB, P = .005).
  
  
  CONCLUSIONS
  Long-term hearing results from intact canal wall mastoidectomy with tympanoplasty are excellent, with the majority of patients maintaining a small air-bone gap long term. The presence of a stapes and/or malleus handle confers improved long-term hearing outcomes.
authors.affiliation: Division of Otolaryngology, Salt Lake City, Utah, U.S.A.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Wilson
authors.forename: Nyall R
authors.initials: NR
authors.lastname: London
authors.forename: Clough
authors.initials: C
authors.lastname: Shelton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult
keywords: Cholesteatoma; hearing; mastoidectomy; tympanoplasty