Canal Cholesteatomas: Proposed Guidelines Based on Otologic Practices at a Tertiary Care Center.

Objective: This study aims to analyze disease and treatment patterns at a tertiary care center and propose guidelines for the management of canal cholesteatomas.

Study design: A retrospective cohort study.

Setting: This study involves patients diagnosed and treated with external auditory canal cholesteatomas (EACC) from January 1, 2010, to January 1, 2021 at the University of Florida, a tertiary care center.

Methods: Inclusion criteria included a diagnosis of EACC with at least 1 follow-up visit after diagnosis. Patient demographics, risk factors, etiology if acquired, EACC characteristics such as location and staging, and treatment modality were recorded and analyzed. The primary outcome was a recurrence of disease.

Results: Out of the 175 patients reviewed, 90 patients and 100 ears met the criteria. Most patients were treated with surgery (81%, N = 81) as opposed to medical management (ie, serial debridement). While there were no factors that were significant for higher odds of surgical intervention, all Stage IV (n = 9) and superior canal wall locations (n = 8) were treated with surgery. Mastoidectomy was more likely to be performed in higher staged cholesteatomas (χ² = 13.41, P = .0012) and posterior canal cholesteatoma location (odds ratio [OR] = 11.20, P = .0001), whereas anterior (OR = 0.11, P = .0390) and inferiorly located EACCs (OR = 0.22, P = .0169) had more odds of being treated with canalplasty/tympanoplasty. Recurrence was seen up to 4.78 years after surgery.

Conclusion: Disease location and staging and patient factors should be considered in the shared management decision-making of EACC treatment. Surveillance duration should be up to 5 years.