Abstract: Objective This study aimed to investigate the efficacy of open mastoidectomy or complete wall tympanotomy, combined with facial nerve decompression, in improving facial paralysis among patients with middle ear cholesteatoma. Methods The facial nerve House-Brackmann classification system was used. There were 9 grade Ⅲ cases, 11 grade Ⅳ cases, and 5 grade Ⅴ cases. Among them, two patients presented with lower eyelid eversion. The patients were grouped according to the time interval between the onset of facial paralysis and the operation. Group 1 consisted of 13 patients who underwent surgery within 30 days after developing facial paralysis. There were seven grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case in this group. Group 2 consisted of eight patients who underwent surgery within 30 to 60 days after developing facial paralysis. This group had two grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case. Group 3 consisted of four patients who underwent surgery 60 to 90 days after developing facial paralysis. The group included one grade Ⅳ case and three grade Ⅴ cases. All patients were evaluated three and six months postoperatively. Results All 25 patients had successful surgeries with significant improvement noted three months postoperatively. There were seven grade Ⅰ cases, six grade Ⅱ cases, nine grade Ⅲ cases, and three grade Ⅳ cases(P<0.001). Further improvement was noted six months postoperatively with 17 grade I cases, three grade Ⅱ cases, and five grade Ⅲ cases(P<0.001). However, the improvement from the third postoperative month to the sixth postoperative month was insignificant(P=0.076). The treatment effect of group 1 was better than those of groups 2 and 3. No significant improvement in facial paralysis was observed three months after the operation in groups 2 and 3. However, a significant improvement was noted during the sixth postoperative month for these groups(P<0.001). The improvement from the third postoperative month to the sixth postoperative month was insignificant (P=0.223). Conclusion Surgery within 30 days from the onset of facial paralysis resulted in the most favorable outcomes in patients with middle ear cholesteatoma, complicated with facial paralysis. The treatment effect peaked within 30-90 days postoperatively. However, the improvement was gradual, and a drastic improvement was noted six months postoperatively. Favorable outcomes were still achieved within three months postoperatively among surgically treated patients with middle ear cholesteatoma.

Key words: Middle ear cholesteatoma, Facial paralysis, Mastoidectomy, Facial nerve decompression, Surgery