ABSTRACT
BACKGROUND AND OBJECTIVES: The canal wall down (CWD) precedure provides relatively safer access and lower recidivism rate compared to the canal wall up (CWU) procedure. Choice of initial surgical procedure and staging can be variable according to the surgeon's preference and experience. Aims of this study were to analyze the frequency and causes of reoperation and to analyze postoperative hearing results between two groups according to the status of stapes and staging. MATERIALS AND METHODS: Initial surgical management for 179 cases of cholesteatoma performed by 2 senior authors from 1993 through 1998 were reviewed retrospectively. RESULTS: CWD procedure was the preferred procedure (n=151, 84%) and surgery for hearing gain was performed in 103 cases regardless of staging. The numbers and causes of reoperation were analyzed. In CWD cases, the emergence of recidivism (i.e., residual or recurrent cholesteatoma) persisted during the follow up and annual rate of recidivism was around 2%. Between CWD and CWU group, there was no statistical difference in the annual incidence of recidivism. Hearing results according to the types of mastoidectomy and the status of stapes were analyzed at 1 year of the follow up. Air-bone gap closure (ABG closure) didn't show any differences in both groups. In both groups, there were no statistical differences in the ABG closure according to the status of stapes. CONCLUSION: Even though CWD surgery was mainly performed in extended and advanced cases, the rate of recidivism and postoperative hearing results showed no statistical differences between the two groups. A well-performed primary canal wall down surgery is safe with a few problems requiring no further procedure in cholesteatoma surgery.