Introduction: An insidious problem hampering treatment of cholesteatoma is the propensity of the disease to recur; this is considered to be a particular problem after intact canal surgery.

We continue to perform intact canal surgery for cholesteatoma, because this allows preservation of the ossicular chain, which has been shown to provide the best hearing after cholesteatoma surgery.

We review a technique developed in our institution thirty years ago to minimise recurrence of cholesteatoma after intact canal cholesteatoma surgery.

Method: Inclusion criteria: ears with attic cholesteatoma that underwent reconstruction of the lateral attic wall at primary surgery using bone pate.

Patients underwent second look procedures to exclude residual disease. This afforded an opportunity to further strengthen the lateral attic wall, if needed.

Patients were reviewed annually until five years after their original surgery.

The primary outcome was the need for further surgery for recurrent cholesteatoma.

Life table analysis was used to take account of patients lost to follow up before five years.

Results: 150 ears were included.

Ninety six per cent of the ears survived to five years without need for further surgery due to recurrent cholesteatoma.

Conclusion: Reconstruction of the lateral attic wall in staged intact canal cholesteatoma surgery with bone pate reduced the risk of recurrent cholesteatoma to levels similar to those seen in the best alternative techniques.

Learning Point: Surgery aimed at maintaining the best hearing after cholesteatoma surgery need not be associated with high rates of recurrent cholesteatoma.