European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 3, pp 691–698 | Cite as

Five-year postoperative outcomes of modified staged canal wall up tympanoplasty for primary acquired cholesteatoma

  • Masahiro Komori
  • Naoaki Yanagihara
  • Jun Hyodo
  • Ryosei Minoda
  • Yasuyuki Hinohira



For successful canal wall up tympanoplasty (CWUT) for the treatment of cholesteatoma, the restoration of stable middle ear aeration is also important; however, little is known about the dynamics of such aeration or the optimal surgical procedure. In this study, alternative additional surgical procedure was selected based on the grade of middle ear aeration during the second-stage operation.

Subjects and methods

Patients included in this study underwent staged CWUT surgeries with mastoid cortex plasty (MCP) for well-aerated ears (grade 3) and bony mastoid obliteration (BMO) for poorly aerated ears (grade 2–0). Of the 115 ears included in this study, 62 were followed for more than 5 years. Recurrence rates with deep retraction pocket formation were assessed using the Kaplan–Meier survival analysis. The aeration was graded as: 0, no aeration; 1, aeration of only the mesotympanum; 2, aeration of the entire tympanic cavity; and 3, aeration of both the tympanic and mastoid cavities.


No recurrence was observed in ears associated with grade 3 aeration that underwent MCP or in ears with grade 2 aeration that underwent BMO during second-stage surgery. For grades 0 and 1 aeration ears, the recurrence rates were 8.1% after 5 years and 12.5% after 10 years (p < 0.05), and the aeration of recurrent ears deteriorated to grade 0.


Aeration during second-stage surgery predicts the final outcome.


Staged tympanoplasty Intact canal wall up tympanoplasty Computed tomography Middle ear aeration level 



There was no financial and material support for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtolaryngologyTakanoko HospitalMatsuyamaJapan
  2. 2.Department of OtolaryngologySchool of Medicine, Kochi UniversityNankokuJapan
  3. 3.Department of OtolaryngologyKumamoto General HospitalYatsushiroJapan
  4. 4.Department of OtolaryngologyKamio Memorial HospitalTokyoJapan

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