Recurrence in Cholesteatoma Surgery and the Use of Laser

Objective: Cholesteatomas have a high-rate of recurrence, regardless of the surgical approach used. Our hypothesis was that use of the handheld CO2 laser would reduce recurrence of cholesteatoma by removing microscopic disease, particularly in challenging or difficult to treat areas. Method: A total of 384 mastoidectomies performed by a single-surgeon between 2006 and 2011 were reviewed (22 in the non-laser and 23 in the laser group that met the inclusion criteria). Outcome measures included recurrence rate and complication rates. Independent variables included smoking status, bilaterality and the extent of disease as assessed by Marres staging (1984). Results: Average follow-up was 25 months; average separation between the first and second stage was 8 months. There were 1 Marres stage 1, 29 stage 2, 1 stage 3, and 13 stage 4 patients and the distribution between the 2 groups was similar. There were no facial nerve paralysis cases, and 1 sensorineural (SNHL) hearing loss after the first procedure in the nonlaser group. There was no difference in the rate of recidivism noted at the second stage between the laser group (34.8%) and nonlaser group (30.4%). There was no apparent correlation between smoking status or bilaterality of disease and recurrence. Conclusion: While the safety of cholesteatoma surgery with handheld laser is confirmed without any incidence of SNHL or facial nerve paresis, in this retrospective study, there does not appear to be any reduction in the rate of recidivism. A prospective study is clearly warranted to demonstrate efficacy.