Learning Objectives:

Purpose: The purpose of this study was to calculate long term recurrence rates of cholesteatoma and to identify significant indendepedent prognostic factors for the recurrence.

Materials and Methods: 147 children and adults operated for debuting cholesteatoma, primarily by CWU (canal wall up) mastoidectomy, at Aarhus University Hospital in the period 2001–2005 were included. Five- and ten-year Kaplan-Meier cumulative recurrence rates were calculated and significant prognostic factors were identified by Cox multivariate regression analyses. One year pre to post-operative hearing outcomes were assessed.

Results: Five and ten year recidivism rates (with confidence intervals) were 0.38 (0.31–0.46) and 0.44 (0.37–0.53) respectively. The same estimates from purely CWU with single-stage ossiculoplasties were 0.39 (0.3–0.51) and 0.49 (0.39–0.60) respectively. Independent significant prognostic factors were: Age below 15 years, extension of cholesteatoma into the mastoid, erosion of the incus, and erosion of the stapes. Overall, there was a significant pre- to post-operative air-bone gap (ABG) improvement of 4.05 dB (1.0–7.1).

Conclusions: Long term recurrence rates and prognostic factors of CWU mastoidectomy help decision making in surgical approach and risk stratification of patients. Especially children with large choleateomas extending into the mastoid and with concomitant bone erosions should be carefully followed up.