Conflicting reports and surgeon opinions have contributed to a long-standing debate regarding the merits of the intact canal wall versus canal wall down approach to cholesteatoma. The objective of this analysis was to identify and synthesize available data concerning rates of recidivism after the two primary types of cholesteatoma surgery. PubMed, Cochrane Collaboration, and Google Scholar searches were performed and articles filtered based on predetermined exclusion criteria. Individually reported rates of recurrent and residual disease were extracted and recorded. Meta-analysis demonstrated a relative risk of 2.87 with a confidence interval of 2.45–3.37, confirming a significantly increased incidence of postoperative cholesteatoma when using an intact canal wall approach rather than a canal wall down approach. Next, rates of recidivism following the typical two-stage intact canal wall operation were compared with a single-stage canal wall down operation and found to be similar. In conclusion, we advocate that greater consideration should be given to the canal wall down procedure in initial surgical management and identify the need for further exploration of rates of recidivism after staged or second-look procedures.

Keywords:
Cholesteatoma, Recurrence, Intact canal wall, Meta-analysis, Recidivism, Canal wall down
1.
Abramson M, Lachenbruch PA, Press BH, McCabe BF: Results of conservative surgery for middle ear cholesteatoma. Laryngoscope 1977;87:1281–1287.
2.
Austin DF: Single-stage surgery for cholesteatoma: an actuarial analysis. Am J Otol 1989;10:419–425.
3.
Brown JS: A ten year statistical follow-up of 1,142 consecutive cases of cholesteatoma: the closed vs. the open technique. Laryngoscope 1982;92:390–396.
4.
Cody DT, McDonald TJ: Mastoidectomy for acquired cholesteatoma: follow-up to 20 years. Laryngoscope 1984;94:1027–1030.
5.
Gantz BJ, Wilkinson EP, Hansen MR: Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734–1740.
6.
Ho S, Kveton J: Efficacy of the 2-staged procedure in the management of cholesteatoma. Arch Otolaryngol Head Neck Surg 2003;129:541–545.
7.
Hulka G, McElveen J: A randomized, blinded study of canal wall up versus canal wall down mastoidectomy determining the differences in viewing middle ear anatomy and pathology. Am J Otol 1998;19:574–578.
8.
Jindal M, Riskalla A, Jiang D, Connor S, O’Conner AF: A systematic review of diffusion-weighted magnetic resonance imaging in the assessment of postoperative cholesteatoma. Otol Neurotol 2011;32:1243–1249.
9.
Karmarkar S, Bhatia S, Saleh E, DeDonato G, Taibah A, Russo A, Sanna M: Cholesteatoma surgery: the individualized technique. Ann Otol Rhinol Laryngol 1995;104:591–595.
10.
Mercke U: The cholesteatomatous ear one year after surgery with obliteration technique. Am J Otol 1987;8:534–536.
11.
Nadol JB: Causes of failure of mastoidectomy for chronic otitis media. Laryngoscope 1985;95:410–413.
12.
Nikolopoulos T, Gerbesiotis P: Surgical management of cholesteatoma: the two main options and the third way – atticotomy/limited mastoidectomy. Int J Pediatr Otorhinolaryngol 2009;73:1222–1227.
13.
Nyrop M, Bonding P: Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol 1997;111:521–526.
14.
Palva T: Surgical treatment of chronic middle ear disease. II. Canal wall up and canal wall down procedures. Acta Otolaryngol 1987;104:487–494.
15.
Quaranta A, Cassano P, Carbonara G: Cholesteatoma surgery: open vs. closed tympanoplasty. Am J Otol 1988;9:229–231.
16.
Reimer A, Andreasson L, Harris S: Surgical treatment of cholesteatoma: a comparison of closed and open techniques in a follow-up of 164 ears. Clin Otolaryngol Allied Sci 1987;12:447–454.
17.
Roden D, Honrubia VF, Wiet R: Outcome of residual cholesteatoma and hearing in mastoid surgery. J Otolaryngol 1996;25:178–181.
18.
Sadé J: Treatment of cholesteatoma. Am J Otol 1987;8:524–533.
19.
Sanna M, Zini C, Scandellari R, Jemmi G: Residual and recurrent cholesteatoma in closed tympanoplasty. Am J Otol 1984;5:277–282.
20.
Sheehy JL, Crabtree JA: Tympanoplasty: staging the operation. Laryngoscope 1973;83:1594–1621.
21.
Smyth GD: Surgical treatment of cholesteatoma: the role of staging in closed operations. Ann Otol Rhinol Laryngol 1988;97:667–669.
22.
Smyth GD: Cholesteatoma surgery: the influence of the canal wall. Laryngoscope 1985;95:92–96.
23.
Smyth GD: Post-operative cholesteatoma; in McCabe BF, Sadé J, Abramson M (eds): First International Conference on Cholesteatoma. Birmingham, Aesculapius, 1977, pp 355–362.
24.
Syms M, Luxford W: Management of cholesteatoma: status of the canal wall. Laryngoscope 2003;113:443–448.
25.
Tos M, Lau T: Late results of surgery in different cholesteatoma types. ORL 1989;51:33–49.
26.
Uzun C, Kutoglu T: Assessment of visualization of structures in the middle ear via Tos modified canal wall-up mastoidectomy versus classic canal wall-up and canal wall-down mastoidectomies. Int J Pediatr Otorhinolaryngol 2007;71:851–856.
27.
Vartiainen E, Nuutinen J: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol 1993;14:507–511.
28.
Zahnert T, Offergeld C: Quality management in middle ear surgery: controversies regarding preoperative imaging. ORL 2010;72:159–167.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.