Learning Objectives: To learn if different strategies for ossicular chain reconstruction in cholesteatoma surgery have effect on the hearing results.

Background: Diffusion-weighted MRI imaging lowers the need for second-look surgery to evaluate the presence of residual disease. This strategy will increase the need to perform the best hearing restoration within the primary surgery to avoid a second surgery. It is unknown if single-stage management of cholesteatoma will achieve equal or better hearing results than a staged procedure.

Objective: To analyze the hearing results in ossicular chain reconstruction (OCR) during primary surgery compared to staged OCR in canal wall up mastoidectomy for cholesteatoma.

Study design: Retrospective comparative cohort study.

Patients: All patients with canal wall up mastoidectomy for cholesteatoma from 2003 to 2015 were consecutively selected. Patients who underwent OCR and met the inclusion criteria were divided in two groups: 45 patients with OCR during primary surgery and 46 patients with OCR during staged surgery.

Main outcome measure: Air-bone gap (ABG) improvement.

Results: Overall hearing results showed 56% of the patients achieving an ABG primary surgery OCR versus 7.6 dB for the staged OCR. The outcome measures were corrected for the confounders (age, type of OCR, destruction of malleus/incus/stapes). Only destruction of the stapes proved to be of significant influence. After correction for stapes destruction, the found difference in ABG improvement could not be assigned to the performance of primary or staged OCR.

Conclusion: There is no difference in ABG improvement after OCR during primary surgery compared to OCR during staged surgery.