Single-stage surgery for cholesteatoma: an actuarial analysis.

Single-stage surgery was used for 215 operations for cholesteatoma. The results were analyzed using months at risk (actuarial) statistics. The methods of data collection and of creating a life-table for cholesteatoma follow-up are described. Ninety-one canal-down procedures are compared with 124 canal-up procedures as to the recidivism rate as well as hearing results. The actuarial tables showed a 45% cumulative success rate for canal-up procedures versus a 90% rate for canal-down operations. The successful canal-up procedures demonstrated slightly better hearing results, however. These success rates seemed to be comparable to those using planned staged surgery. It was concluded that, if single-stage canal-up procedures were used with larger mastoids and canal-down procedures with smaller mastoids, 80% of patients could be controlled without either residual or recurrent disease appearing. For the others, it was felt safe to wait for the disease to reappear rather than to do planned two-stage procedures for all patients. It was further urged that actuarial statistics be employed when reporting the results of surgery for cholesteatoma.