Postoperative tympanic membrane retraction and recurrence rate in primary acquired cholesteatoma

Objective: To investigate and compare the clinical characteristics and follow-up results of postoperative tympanic membrane (TM) retraction (without formation of a retraction pocket) and the recurrence rate (reformation of the retraction pocket) of different types of acquired cholesteatomas. Methods: Ninety-nine patients (99 ears, one ear per patient) with primary acquired cholesteatoma who had undergone surgery between January 2011 and July 2012 were divided into pars flaccida, pars tensa, and combined groups according to the initial location of the retraction pocket with cholesteatoma. Canal wall up (CWU) and canal wall down (CWD) tympanomastoidectomies were performed in 17 and 82 patients, respectively. We analyzed the clinical data and followed up the patients every 6 months. Postoperative TM retraction and recurrence rates were calculated by Kaplan-Meier survival analysis. Cox regression model analysis was used to calculate the relative risk of each potential confounding factor of postoperative TM retraction and cholesteatoma recurrence. Results: Surgical techniques, Eustachian tube (ET) function, stapes integrity, preoperative TM adhesion rates, and postoperative TM retraction rates were significantly different among the three groups. We found a significant difference in the cumulative postoperative TM retraction rates among the three groups; however, the cumulative recurrence rates were not significantly different among the groups. Combined cholesteatoma, ET dysfunction, and preoperative TM adhesion, which increased the risk of postoperative TM retraction showed no significant correlation with cholesteatoma recurrence. Conclusion: Different types of cholesteatomas have different clinical characteristics. CWD tympanomastoidectomy combined with mastoid obliteration and soft-wall reconstruction is a reliable surgical technique for pars tensa and combined cholesteatoma.