Objective: The purpose of this study was to evaluate how various sociodemographic factors such as rurality, age, race, body mass index, and sex affect the surgical management of cholesteatoma. Canal wall-down (CWD) tympanomastoidectomy and longer surgical times were used as potential proxies for increased severity of disease.
Study design: Retrospective.
Setting: A tertiary academic center.
Methods: All patients who underwent primary tympanomastoidectomy for cholesteatoma at the University of Kentucky from January 2008 through September 2023 were reviewed in this study. The rurality of the patient's home county was defined as metro, rural, or very rural as delineated by Rural-Urban Continuum Codes. Unadjusted and adjusted linear and logistic regression models were used to assess differences in the rate of CWD procedure and surgical times, respectively, across sociodemographic variables.
Results: A total of 604 patients were included in the study. Male sex and increased age were positively and inversely correlated with length of surgery, respectively, in the adjusted models. No significant difference was found in the rate of CWD procedures in rural or very rural patients compared to metro (P = .989). No significant difference was found in surgical time in rural or very rural patients compared to metro (P = .885).
Conclusion: Age and sex were significant predictors of surgical time, while no associations were found between any sociodemographic factor and type of tympanomastoidectomy. No significant association was found between rurality and the 2 proxies used. Our findings refute the thinking that patients requiring surgery for cholesteatoma from socioeconomically and educationally disadvantaged areas require longer or more involved surgeries.
Keywords: barriers; cholesteatoma; health care disparities; neurotology; otology; severity of disease; surgical management.
© 2025 American Academy of Otolaryngology–Head and Neck Surgery Foundation.