A Study on Surgical Outcomes of Pars Flaccida Cholesteatoma

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In this study, we reviewed the data of 115 patients with pars flaccida cholesteatoma who underwent initial surgery at the Yamanashi University Hospital between January 2010 and December 2017. For cases of pars flaccida cholesteatoma that had progressed to the mastoid antrum, we chose to perform canal wall down tympanoplasty with soft wall reconstruction. On the other hand, for cases in which the disease had not progressed to the mastoid antrum, we chose to perform transcanal atticotomy. We analyzed the rates of recurrence, favorable hearing improvement rates, and the postoperative ear canal morphology after the tympanoplasties. According to the degree of progression of the disease, the patients were classified as stage I (16 cases, 13.9%), stage II (91 cases, 79.1%), stage III (7 cases, 6.1%), or stage IV (1 case, 0.9%). Transcanal atticotomy was performed in 11 cases (9.6%), and canal wall down tympanoplasty in 104 cases (90.4%). The overall recurrence rate was 8.7% (10/115), and all the recurrences were cases of residual disease. In 8 cases, the recurrence was found during the planned second-look operation. After the operation, more than half of the cases (62.8%) developed retraction of the canal wall, but cavity problem was observed only in 2 cases. The overall hearing improvement rate was 77.0% (67/87). The hearing improvement rate in type I tympanoplasty cases was 92.9% (13/14), while the rate in type III tympanoplasty cases was 75.4% (52/69), and that in type IV tympanoplasty cases was 50.0% (2/4). From the above, we conclude that both transcanal atticotomy and canal wall down tympanoplasty with soft wall reconstruction are effective for preventing recurrence and postoperative cavity problems in cases of pars flaccida cholesteatoma. The hearing improvement rates were not inferior to previously reported rates, but we would like to investigate whether further improvement can be expected with the use of artificial ossicles in type IV tympanoplasty.

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