Surgical treatment of cholesteatoma: a comparison of closed and open techniques in a follow-up of 164 ears.

In the Malmö community (230,000 inhabitants) 188 ears with cholesteatoma were operated on during 1975-1981. This number corresponds to an incidence of 12 cholesteatomas per 100,000 inhabitants a year. A detailed follow-up was possible in 164 ears. The primary operation was performed with an intact canal wall technique (CAT) in 148 ears and a radical operation in 40 ears. A planned second look was performed in 138 of the CAT ears and residual cholesteatoma was found in 41 or 30%, mainly in the epitympanic space. An initially good healing and hearing result was obtained in 71% but in the course of time several ears developed new retractions and a new mastoid cholesteatoma. The number of ears with perfect hearing tended to decrease with time, but about one-third of CAT ears remained intact with good hearing. The CAT technique is preferable in ears with a large mastoid air cell system and when the cholesteatoma is easily accessible by the approach. A planned second look should be performed including ossiculoplasty and obliteration of the antrum. In the remaining cases a radical operation including middle ear reconstruction and obliteration of the mastoid cavity is preferred.