title: The disease recurrence rate after the canal wall up or canal wall down technique in adults.
abstract: OBJECTIVE
  To review which type of cholesteatoma surgery, canal wall up (CWU) or canal wall down (CWD), provides the lowest risk for residual and/or recurrent disease in adults with primary acquired cholesteatoma.
  
  
  METHODS
  PubMed, Embase, CINAHL, the Cochrane Library, Scopus and Web of Science.
  
  
  METHODS
  We selected articles comparing CWU with CWD, reporting on disease recidivism (combined residual and recurrent disease) or independent residual or disease recurrence rates. We included studies with a moderate to high relevance.
  
  
  RESULTS
  Our search yielded 2,060 articles. We selected seven studies that carried a moderate risk of bias. Six studies described higher disease recidivism after the CWU procedure [16.7-61.0%] compared to the CWD technique [0-13.2%]. Four studies showed statistical significant difference (P < .05). One study showed opposite results: recidivism was found in 7.8% CWU and in 22.1% CWD cases (P < .001). Studies showed CWU recidivism more likely to be residual disease, whereas CWD recidivism tended to be recurrent disease.
  
  
  CONCLUSIONS
  The majority of included studies showed CWU to result in more disease recidivism compared to the CWD technique in adult patients with a primary acquired cholesteatoma. If recidivism risk is the most important factor to consider a certain surgical technique, we recommend application of the CWD procedure. However, many additional factors in patient care will define the best treatment decision, such as residual hearing and access to health care. Our recommendations are based on Level II evidence, which underlines the need for future high-level evidence studies.
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Kelly G P
authors.initials: KG
authors.lastname: Kerckhoffs
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Maarten B J
authors.initials: MB
authors.lastname: Kommer
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Thom H L
authors.initials: TH
authors.lastname: van Strien
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Simeon J A
authors.initials: SJ
authors.lastname: Visscher
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.|Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Bruijnzeel
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Adriana L
authors.initials: AL
authors.lastname: Smit
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.|Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods*
keywords: Cholesteatoma; canal wall down; canal wall up; hearing loss; hearing outcome; recurrence; residual disease