Prevention of Recurrent Cholesteatoma in Closed Tympanoplasty

Recurrent cholesteatoma in a series of 534 staged intact canal wall tympanoplasties performed over a 10-year period has been reviewed for the present study. Overall detected incidence of recurrent cholesteatoma is 5.2% (28 of 534 operated ears). A steady decrease of recurrent cholesteatoma was found, however, in the second period of our surgical experience (1978 to 1982) when prevention techniques were adopted in all operations, resulting in a 1.07% incidence (four of 373 operated ears). Our present policy for prevention of recurrent cholesteatoma in intact canal wall tympanoplasties with mastoidectomy includes 1) the use of plastic sheeting with thick Silastic, 2) the repair of bony sulcus defects with cartilage shavings, 3) staging of the operation with preplanned reexploration of the middle ear and mastoid, and 4) transtympanic ventilation tube insertion in cases of refractory tubal insufficiency.