title: Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma.
abstract: To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.
  
  
  
  Retrospective review and cost analysis.
  
  
  
  Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.
  
  
  
  One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001).
  
  
  
  The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed.
  
  
  
  4. Laryngoscope, 126:2574-2579, 2016.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A. matthew.crowson@dm.duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Crowson
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: Vaibhav H
authors.initials: VH
authors.lastname: Ramprasad
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: Nikita
authors.initials: N
authors.lastname: Chapurin
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: Calhoun D
authors.initials: CD
authors.lastname: Cunningham
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
authors.forename: David M
authors.initials: DM
authors.lastname: Kaylie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000191:economics* / Q000379:methods; D055815:Young Adult
keywords: Cholesteatoma; mastoidectomy; second look; tympanoplasty