Mastoidectomy for acquired cholesteatoma: follow-up to 20 years.

The results of 423 mastoidectomies for acquired cholesteatoma were reanalyzed 6 years after the first analysis. The mastoidectomies were placed into three groups: open-cavity, 135 modified radical and 37 radical; obliterated-cavity, 60 modified radical and 20 radical in which the mastoid cavities were obliterated with pedicle muscle grafts; and intact-canal-wall, 69 complete and 102 complete with opening of the facial recess. The following observations were made. The cholesteatoma failure rate increased: for the open-cavity group, from 6% to 7%; obliterated-cavity group, 16% to 18%; intact-canal-wall group, 35% to 45%. The precholesteatoma (retraction pocket) failure rate in the open-cavity and obliterated-cavity groups did not change. In the intact-canal-wall group, recurrent cholesteatomas developed in 8 cases initially classified as precholesteatoma failures. In 9 initially classified as successful, retraction pockets developed and 7 of these went on to recurrent cholesteatomas. Consequently, despite the progressive increase in formation of retraction pockets, the overall incidence dropped from 20% to 16%. Failure due to chronic or frequent recurrent infection did not change in the open-cavity and intact-canal-wall groups. However, in the obliterated-cavity group, it increased from 4% to 5%. The overall failure rate increased: open-cavity group, 18% to 19%; obliterated-cavity group, 29% to 30%; intact-canal-wall group, 60% to 66%.