Milan Stankovic1, Rade Kosanovic and Petar Stankovic
Objective: To review the effect of learning curve on the audiological results of patients surgically treated for cholesteatoma. Study design: Retrospective review of patients records in tertiary referral center. Patients: Retrospective study of 758 patients operated by one surgeon for acquired middle ear cholesteatoma divided into two periods. The patients were divided into three age groups: children, adolescents, and adults. The localization of cholesteatoma was classified as: attic, sinus, or tensa. Audiological results were followed during shortterm and long-term period. Interventions: Patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. Reoperations were performed when needed. Main outcome measures: Preoperative and postoperative air bone gap (ABG) was compared in different groups. Results: In short term follow up the surgical experience was found significant for: attic and sinus tympani site, adult patients, absent manubrium mallei, closed technique, unilateral cholesteatoma, and primary surgery. During long tem follow up experience resulted in better audiological results for: all sites of cholesteatoma, adolescents and adults, all types of ossicular damage, uni- and bilateral cholesteatoma, for closed technique, and both for primary and revision operations. Conclusion:Obtained experience during surgical treatment for cholesteatoma was significantly influential on the improvement of audiological results of different aspects of cholesteatoma elimination, particularly for difficult and advanced cases, such as attic cholesteatoma, bigger ossicular damage, and closed surgical technique.