Junaid KALLIYATH, Codruta NEUMANN
The Journal of International Advanced Otology - 2026;22(5):1-6
BACKGROUND: Cholesteatoma is an invasive temporal bone lesion requiring surgical intervention, but recurrence remains a major challenge. Obliteration of the epitympanum during primary combined approach tympanoplasty (CAT) shows promise in reducing recidivism. METHODS: A retrospective cohort study was conducted on 110 patients who underwent primary CAT for cholesteatoma (September 2014 to January 2023). Patients were divided into a non-obliteration group (n = 56) and an obliteration group (n = 54), based on a change in surgical technique in June 2018. The primary outcome was cholesteatoma recidivism, confirmed by intra-operative findings during revision CAT. Kaplan-Meier survival analysis was used to assess recurrence-free survival. RESULTS: The obliteration group demonstrated a significantly lower rate of recidivism (5.56%) compared to the non-obliteration group (30.36%). This corresponded to an absolute risk reduction of 24.8%, odds ratio of 0.13 (95% CI: 0.04-0.49; P < .005), and an 87% reduction in odds of recurrence. All cases of recidivism in the obliteration group were residual disease, whereas both residual (15%) and recurrent (16%) disease were seen in the non-obliteration group. Kaplan-Meier analysis confirmed superior recurrence-free survival in the obliteration group (P < .001), with sustained benefit over 60 months. STAMCO stage III disease accounted for all recurrences in the obliteration group, highlighting its value in advanced cases. CONCLUSION: Bone pâté obliteration of the epitympanum during CAT significantly reduces cholesteatoma recurrence, particularly in advanced disease, and should be considered as a routine adjunct to reduce cholesteatoma recurrence.
