122 / 264
cholesteatoma when taken to the operating room, and
none had residual cholesteatoma.
There were three (3.8%) CWU patients who had a
complication following their first tympanoplasty-
mastoidectomy, including postoperative nausea and vom-
iting requiring admission, a tegmen defect with cerebro-
spinal fluid leak, and a surgical site infection. For CWU
patients undergoing a second-look procedure, two (4.3%)
patients experienced a complication including encephalo-
cele and a wound seroma.
For the purposes of assessing the audiology outcomes,
CWU patients were grouped into second-look and no
second-look cohorts. When examining WRSs and ABGs at
pre-, immediate postoperative, and the latest follow-up vis-
its, there were no significant differences observed (Table I)
(
P
>
0.05 for all variable pairs). In all CWU patients, no
OCR was completed in 42 (52.5%) patients. Seven (8.8%)
patients had OCR at a planned single-stage procedure and
31 (38.8%) at a planned second-look procedure. The pre-
and posttreatment air conduction pure tone average and
WRS results for all CWU patients are reported in supple-
mental figures (Figs. 1 and 2, respectively).
Charges and costs for the components of care were
tabulated (Table II). The most expensive charge component
was the surgical procedure, followed by the CT scan of the
temporal bones. A cost analysis demonstrated that
patients with a second-look strategy had a significantly
higher number of postoperative visits compared to patients
with no second look (10.4 visits vs. 6.32;
P
5
0.0007)
(Table III). There was no significant difference in follow-up
period, temporal bone CTs, and audiology clinic visits
(each
P
>
0.05). Canal wall-up procedures patients with a
second-look management strategy had a significantly
higher cost of care versus patients with no second-look
strategy (USD mean of $41,411 vs. $23,529;
P
<
0.0001).
DISCUSSION
The primary goal of cholesteatoma surgical manage-
ment is to produce a safe ear, with a secondary goal to
TABLE I.
Audiometric Outcomes for CWU Patients Who Underwent Either Second Look or No Second-Look Operative Strategy.
Mean (CI 95%)
No Second Look
Second Look
P
Value*
Preoperative air bone gap
21.2
(16.8–25.6)
26.4
(22.8–30.1)
0.07
Preoperative WRS
85.0
(77.9–92.0)
92.8
(86.5–99.1)
0.10
Postoperative air bone gap
21.7 (17.1–26.2)
27.0 (23.2–30.8)
0.08
Postoperative WRS
83.2 (75.2–91.3)
91.0 (84.2–97.9)
0.14
Most recent air bone gap
23.7
(18.3–29.1)
28.2
(23.7–32.7)
0.21
Most recent WRS
85.8
(77.1–94.5)
90.5
(83.7–97.2)
0.40
WRS change preoperative to postoperative
2
4.58 (
2
12.2–3.07)
2
1.87 (
2
8.71–4.98)
0.60
WRS change postoperative latest
2
2.48 (
2
8.87–3.91)
2
1.27 (
2
6.61–4.08)
0.77
WRS change preoperative latest
2
2.86 (
2
10.89–5.17)
2
3.16(
2
9.77–3.45)
0.95
*One-way ANOVA. Two-tailed.
ANOVA
5
analysis of variance; CI
5
confidence interval; CWU
5
canal wall-up procedures; WRS
5
word recognition score.
Fig. 1. Pretreatment pure tone average and word recognition
score scattergram.
Fig. 2. Posttreatment pure tone average and word recognition
score scattergram.
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