Single-stage canal wall down tympanoplasty: long-term results and prognostic factors.

OBJECTIVES: We sought to identify factors associated with anatomic and functional results of canal wall-down tympanoplasty. METHODS: One hundred eighty-nine primary or relapsing cholesteatomas were consecutively operated on by a single surgeon. Cholesteatoma recurrence rates were evaluated. Predictive values of the patient, disease, and surgical characteristics on cholesteatoma recurrence were estimated. The effect of these variables on keratin pearl development, recurrent otorrhea or granulation tissue formation, and hearing function was tested. RESULTS: The mean follow-up was 8 years (range, 4 to 15 years). The cholesteatoma relapse rate (+/- SE) estimated by the Kaplan-Meier method was 2.1% +/-1.1%. No variables were associated with relapsing disease. The log-rank test showed a significantly higher probability of keratin pearls in male patients (16.7% versus 2.1%; p = 0.001), young patients (less than 16 years; 51.4% versus 6.2%; p = 0.0001), patients with unencapsulated cholesteatomas (19.5% versus 5.3%; p = 0.06), patients with petrous or accessory cellularity invasion (17.9% versus 7.1%; p = 0.02), and patients with overlay myringoplasty (25% versus 7.9%; p = 0.03). Recurrent otorrhea and granulation tissue were associated with homograft temporalis fascia myringoplasty (14.3% versus 3.8%; p = 0.04). The overall postoperative air-bone gap was within 20 dB in 30.7%; it was within 20 dB in 43.9% (47/107) for intact or reconstructed ossicular chains and in 13.4% (11/82) for nonreconstructed, eroded ossicular chains (p = 0.0001). The air-bone gap was within 20 dB in 42.6% (46/108) when the mucosa of the tympanic cavity was normal and in 14.8% (12/81) when there was granulation tissue within the tympanic cavity (p = 0.0001). CONCLUSIONS: Single-stage canal wall-down tympanoplasty is an appropriate treatment for acquired tympanomastoid cholesteatoma.