Candidates for Revision Tympanoplasty and Implantable Hearing Devices in Cases of Postoperative Hearing Failure in Cholesteatoma.

BACKGROUND: To evaluate postoperative hearing outcomes in patients undergoing tympanoplasty for acquired cholesteatoma and to identify candidates suitable for revision surgery or implantable hearing devices. METHODS: This retrospective study analyzed 177 patients who underwent primary tympanoplasty for acquired cholesteatoma between 2009 and 2015. Postoperative hearing outcomes were classified based on the air-bone gap (ABG), with ≤15 dB defined as successful. Candidates for revision tympanoplasty were identified according to the presence of an intact stapes, aerated mesotympanum on CT, and absence of tympanic membrane adhesion. Eligibility for cochlear implants (CIs), bone-anchored hearing aids (Baha®), and Vibrant Soundbridge (VSB) was assessed following Japan Otological Society (JOS) guidelines. RESULTS: Of 177 patients, 98 (55.3%) had unsuccessful hearing outcomes. Among these, 46 (46.9%) were candidates for revision tympanoplasty and 37 (37.7%) for implantable hearing devices (3 for CI, 13 for Baha®, and 27 for VSB), with partial overlap. Overall, 71 of the 98 patients (72.4%) were eligible for either revision surgery or hearing device implantation. CONCLUSION: More than half of the patients undergoing tympanoplasty for acquired cholesteatoma had suboptimal postoperative hearing; however, many patients remained candidates for additional interventions, highlighting the importance of structured postoperative reassessment, individualized auditory rehabilitation, and collaborative care between physicians and institutions.