title: Cholesteatoma recidivism: comparison of three different surgical techniques.
abstract: OBJECTIVE
  To compare cholesteatoma recidivism rates after exclusive transcanal technique (ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down surgery (CWD).
  
  
  METHODS
  Retrospective case review and clinical case study
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  406 cholesteatoma surgeries (2007-2009), 116 ears in clinical re-examination at least 1 year postoperatively.
  
  
  METHODS
  Sequential cholesteatoma surgery with ETC, TCM, or CWD.
  
  
  METHODS
  Cholesteatoma recidivism, residual and recurrent disease, localization of recidivism, validity of clinical findings.
  
  
  RESULTS
  Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism rates after ICW (15%) and CWD (16%) were almost similar. Recidivism was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease.
  
  
  CONCLUSIONS
  Sequential surgery is an effective and successful strategy in cholesteatoma eradication, providing a similar recidivism rate compared to following cholesteatoma retrograde and resection of the posterior canal wall. Lower recidivism after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism, compared with CWD, as described in other studies. Cholesteatoma recidivism is mainly attributed to the surgeon's experience that outweighs the chosen strategy.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Neudert
authors.forename: Susen
authors.initials: S
authors.lastname: Lailach
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Lasurashvili
authors.forename: Max
authors.initials: M
authors.lastname: Kemper
authors.forename: Thomas
authors.initials: T
authors.lastname: Beleites
authors.forename: Thomas
authors.initials: T
authors.lastname: Zahnert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D002908:Chronic Disease; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult