One-stage reconstruction utilizing mainly autogenous materials was done to assess feasibility, safety, and functional outcome. The study included 31 patients with extensive cholesteatoma. Wide exposure through canal wall-down (CWD) procedure, eradication of the pathology, and establishment of Eustachian tube patency were the principal goals leaving an area free of residual disease suitable for one-stage reconstruction. Autogenous conchal cartilage was utilized for reconstruction of the bony meatal wall. Plasti-Pore TORP prosthesis was used for ossicular reconstruction in cases with absent stapes (seven cases), otherwise, temprofascial flap/graft was applied directly over the stapes head as a columella. Intact, rigid, fully epithelialized canal wall was achieved in 100% of cases within 8 weeks.

Graft failure with persistent middle ear infection occurred in one case (3.2%). Recurrent cholesteatoma occurred in one case that could be managed in the office, and now, it is free of disease. Hearing improvement occurred in 26:31 (83.9%) of cases with no significant difference between cases with columella type and those with TORP prosthesis reconstruction.

We concluded that one-stage reconstruction is a safe procedure in management of extensive cholesteatoma. Autogenous conchal cartilage is a suitable material for canal wall reconstruction. Columella-type tympanoplasty, when stapes is intact, gives good anatomic and functional results without the need for alloplastic materials.