Objective:
To review the audiological results of patients surgically treated for cholesteatoma.

Patients and Methods:
A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990–2002 was performed. A total of 758 patients were followed in the short term and 611 patients in the long term. Localization of cholesteatoma was classified as attic, sinus, or tensa. Closed tympanoplasty was performed as the single procedure of choice on all the children, and reoperation or conversion to open tympanoplasty was made later if needed. Adult patients were treated with single classical canal wall up (CWU), or wall down (CWD), according to the propagation of disease and condition of the middle ear. Preoperative and postoperative air-bone gap (ABG), and pure tone average (PTA), were compared.

Results:
Considering all the patients, hearing improvement (reduction of ABG) amounted to 20 dB in the short term and 18 dB over the long term. Preoperative hearing level was significantly worse for the CWD than for the intact canal wall (ICW) technique. The ABG closure was much better in the group with attic cholesteatoma. Revision operations and bilateral cholesteatoma gave worse total postoperative hearing. Damage of auditory ossicles correlated well with total preoperative and postoperative results.

Conclusions:
The audiological results of cholesteatoma surgery are preserved during long-term follow-up. Poorer preoperative hearing level, CWD tympanoplasty, bilateral cholesteatoma, and ossicular damage, as well as revision surgery, were associated with reduced gains in hearing with surgical management.