Obliteration of the Epitympanum and Mastoid Results in Reduced Cholesteatoma Recidivism: Long-term Outcomes and Technique

Objective: To compare long-term rates of cholesteatoma recidivism between cases undergoing tympanomastoidectomy with obliteration and without obliteration. Study design: Retrospective case-control. Setting: Tertiary referral center. Patients: Adults and older children with pars flaccida cholesteatoma. Intervention: Tympanomastoidectomy with or without obliteration of the epitympanum and mastoid. Main outcome measure: Recidivistic cholesteatoma (ie, residual and/or recurrent cholesteatoma) determined by otoscopy, revision surgery, or imaging. Methods: Retrospective chart review of pars flaccida cholesteatoma surgeries by a single surgeon between 2015 and 2023. Demographic, clinical, and surgical information, inclusive of cholesteatoma type and EAONO/JOS staging. Results: There were 60 cases with obliteration and 63 cases without obliteration that were similar in age, sex, hearing, and cholesteatoma type and stage. Cases with obliteration had statistically significantly lower rates of recurrent (5% vs. 17%, P =0.0447) and residual (3.3% vs. 16%, P =0.0303) cholesteatoma compared with those without obliteration. The overall rate of recidivistic disease was 23.8% in cases without obliteration and 6.8% in cases with obliteration ( P =0.0116). Using Kaplan-Meier analysis, recidivistic cholesteatoma-free survival rates at 5 years for the obliteration and non-obliteration groups were 91% and 63%, respectively ( P =0.0367, log-rank test). No other clinical or surgical factors influenced recidivism. Conclusions: Epitympanum and mastoid obliteration during CWU and CWD tympanomastoidectomy for pars flaccida cholesteatoma is associated with reduced rates of recurrent and residual disease when compared with cases without obliteration.