Attic cholesteatoma. Recurrence rate related to observation time.

Two hundred twenty-four ears with attic cholesteatomas, subjected to one-stage surgery between 1965 and 1978, were reevaluated several times, most recently in 1980/81 at a median observation time of 8 years (range, 3 to 16 years) and in 1985/86 at a median observation time of 11 years (range, 3 to 21 years). The recurrence rate was related to length of observation time. Up to and including the follow-up examination in 1980, the rate of residual cholesteatoma in the tympanic cavity was 1.3% and 0.9% in the attic. The incidence of recurrent cholesteatoma in the attic or the cavity was 1.8%. The total recurrence rate was 4.0%. At follow-up in 1985/86, the total recurrence rate had increased to 6.3%, comprising residual cholesteatoma in the tympanic cavity in 1.8% and in the attic in 0.9% and recurrent cholesteatoma in 3.6%. A total of 133 patients had a modified canal wall up mastoidectomy, whereas 91 patients had canal wall down mastoidectomy with obliteration. With regard to the total results of surgery, no significant differences could be demonstrated between the two methods, and we conclude that canal wall up mastoidectomy can be performed in one stage.