There continues to be debate over the benefits and limitations of different techniques for cholesteatoma surgery. This retrospective review of 132 cases over a 10 year period with primary cholesteatoma from Turkey tried to establish which technique [canal wall up (CWU) or canal wall down (CWD)] was superior in terms of eradication of disease and hearing outcomes. The follow-up of all patients was at least six years in order to improve the reliability of results. Of the 132 patients, 54 patients had CWU surgery, 48 had modified radical mastoidectomy (MRM) and 42 patients had radical mastoidectomy (RM). In terms of cholesteatoma recurrence rates this was 14.8% in the CWU group and 8.3% in the MRM and 4.8% in the RM group. In common with other literature, the most common sites for residual disease were the epitympanum and sinus tympani, areas that are difficult to view intraoperatively; indeed the authors recommend the use of the otoendoscope intraoperatively to view these regions. In terms of hearing gain, this was significantly higher in the CWU group as opposed to the other two groups. Whilst this study would suggest that MRM and RM are superior techniques to CWU surgery, it’s important to note that each individual case is different, and the decision to undertake one technique over another depends on a number of factors such as extent of disease and the patient’s age. For this reason, there may be multiple confounding factors when comparing the groups, so the results must be interpreted with caution. Also, it’s important to note that the terms used for types of chlolesteatoma surgery in this study (CWU, MRM, RM) are largely redundant these days.

Which technique is better for cholesteatoma surgery?
Deniz M, Uslu C, Koldas C, Deniz B.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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