Objectives: To study the influence of the cochleariform process abutment (CPA) of early congenital cholesteatomas (CC) (ECCs) on surgical outcomes. Study Design: Retrospective case review. Setting: University hospital otology referral clinic. Patients: Two hundred consecutive pediatric ECC patients. Interventions: The patients were classified into three groups based on the temporal bone computed tomography (TBCT) findings of ECC: A) the absence of CPA, B) the presence of CPA, and C) the presence of CPA and extension posterior to the malleus handle. Main Outcome Measures: Residual CC according to each of the TBCT and surgical stages during 34.9 ± 20.1 months of follow-up. Results: Group A was significantly associated with effortless delivery without matrix tearing (77%) even with simple myringotomy. Only 17% of group B experienced this outcome, and troublesome matrix tearing occurred in significantly more patients (p
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