A ten year statistical follow-up of 1142 consecutive cases of cholesteatoma: the closed vs. the open technique.

Cholesteatoma has long been a formidable adversary to the otologic surgeon. The surgical treatment has been basically by two methods, open and closed. It was felt that a study should be undertaken to compare the results obtained over a long period of time, utilizing these two methods. A need for this study existed as the same number of new cases of cholesteatoma was presenting each year. In reviewing the literature, it is found that new advancements have not yet been made in the prevention of the disease and the medical and surgical management has remained essentially the same. The ideal goal of successful surgery, namely an ear without disease, with normal hearing, and an intact drum and posterior canal wall, has been difficult to achieve in a high percentage of cases. To achieve this goal, two main surgical methods have evolved: the classical "open method," and the more recent "closed method." In the open method cases, the hearing results were often poor and the cavity presented a management problem. In the closed method there has been a fairly high occurrence of residual, and/or recurrent cholesteatoma which mecessitated a second procedure. These two methods were compared by reviewing a large number of histologically proved cholesteatoma cases 10 years after surgery, to determine the incidence of recurrence of cholesteatoma and the residual hearing function. The results of this study show conclusively that the hearing was better using the closed method, but the recurrence rate was considerably higher. This paper presents a practical method of approach to the management of all presenting cases of cholesteatoma.