The investigation of the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis

Objectives: To investigate the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: Three hundred forty-five patients with middle car cholesteatoma operated on by the same surgeon between 1987 and 2002. Methods: The cumulative recurrence rate of cholesteatoma during a 5-year follow-up period was calculated using Kaplan-Meier survival analysis. Results: The overall 5-year recurrence rate was 11.8%. The recurrence rate increased with the follow-up time. The 5-year recurrence rate was 3.9% in patients treated with canal wall down tympanoplasty (CWDT) and 16.7% in patients treated with intact canal wall tympanoplasty (ICWT) or canal wall reconstruction (CWR) after CWDT with a significant difference (p < 0.01). The 5-year recurrence rate was 26.0% in patients operated on between 1987 and 1996 and 0.7% in patients operated on between 1997 and 2002, again with a significant difference (p < 0.001). Conclusion: Kaplan-Meier survival analysis should be used for calculating the recurrence rate of cholesteatoma. Although this analytic method further demonstrates that CWDT is a more reliable surgical method than ICWT/CWR in reducing cholesteatoma recurrence, clinical judgment should be exercised, and we continue to recommend that a flexible approach should be adopted in deciding whether to perform CWDT or ICWT/CWR for individual cases.