Tympanoplasty With Intact Canal Wall Mastoidectomy for Cholesteatoma: Long-term Hearing Outcomes

Objectives/HypothesisTo 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. Study DesignA 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. MethodsPatient and disease information was collected retrospectively and analyzed. ResultsThere 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). ConclusionsLong-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. Level of Evidence4. Laryngoscope, 123:3168-3171, 2013