{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:48:55Z","timestamp":1786978135729,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T00:00:00Z","timestamp":1456790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single\u2010stage and second\u2010look operative strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective review and cost analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single\u2010stage or second\u2010look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre\u2010\/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow\u2010up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall\u2010up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single\u2010stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre\u2010\/postoperative ABG and WRS between second look and single stage (\n                      <jats:italic>P<\/jats:italic>\n                      &gt; 0.05). Compared to second\u2010look patients, single\u2010stage patients had significantly fewer postoperative visits (6.32 vs. 10.4;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The goal of cholesteatoma surgery is to produce a safe ear, and a second\u2010look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty\u2010mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second\u2010look strategy should be individually tailored and not universally performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      4.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 126:2574\u20132579, 2016\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.25941","type":"journal-article","created":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T00:37:32Z","timestamp":1456792652000},"page":"2574-2579","source":"Crossref","is-referenced-by-count":24,"title":["Cost analysis and outcomes of a second\u2010look tympanoplasty\u2010mastoidectomy strategy for cholesteatoma"],"prefix":"10.1002","volume":"126","author":[{"given":"Matthew G.","family":"Crowson","sequence":"first","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaibhav H.","family":"Ramprasad","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Chapurin","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Calhoun D.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Kaylie","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"1","article-title":"Canal wall for cholesteatoma: up or down? 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