Surgical treatment of cholesteatoma: the role of staging in closed operations.

It has been proposed that closed operations on cholesteatomatous ears should be performed on a two-stage basis in order to detect disease left behind at the first operation and to correct developing retraction pockets. Two groups of patients who had closed operations performed in two stages, 100 combined approach tympanoplasties and 100 mastoid obliterations with tympanoplasty, were observed for 10 years after the second stage. A much greater than expected incidence of eventual cholesteatoma recurrence suggests that even with staging, closed techniques may provide a less than reliable outcome in surgical control of the disease, and long-term observation of ears thus treated is desirable.