Learning Objectives: to confront the otologic community with the non-optimal hearing of individuals with controlled cholesteatoma.

Introduction: Goals of management in cholesteatoma are to create a safe ear (avoiding complications), to achieve a dry and convenient ear and to reach the best possible hearing restoration. Although hearing restoration is not defined as the first priority for treatment in cholesteatoma, it may have serious long-term effects on patient's life.

Methods: The study included two study groups. In one group there were 260 consecutive cholesteatoma surgeries, 128 adults and 132 children . The mean group follow-up was 6.6 ± 12.8 yrs. Hearing thresholds were analyzed according to type of surgery performed and age of the patients (children Vs adults). The other group includes 39 ears of children who were operated after the introduction of routine use of none EPI-diffusion weighted MRI and the complete avoidance of traditional radical cavities. In this group follow up was much shorter (Mean 1.4 ± 1.3 yrs.)

Results: Mean group air conduction (AC) PTA after canal wall up procedures were 38 dB in children and 55 dB in adults. Mean group AC-PTA after canal wall down procedures were 70 dB in children and 60 dB in adults. Group AC-PTA after canal wall up procedures were 38 dB in children and 55 dB in adults. In the group with radical mastoidectomy and reconstruction of the EEC and mastoid obliteration mean group AC-PTA was 40 dB as compared to 60 dB in the canal wall down cases which were left as radical cavities.

Conclusions: The mean AC-PTA of ears with controlled cholesteatoma indicates that hearing is unsatisfactory in many of the individuals with controlled cholesteatoma. When it is evident that hearing is not within normal thresholds (whether ossiculoplasty was performed or not) all relevant rehabilitation options should be offered to the patients, including conventional hearing aids, bone conduction systems, middle ear implants or cochlear implants.