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In cholesteatoma, the prognosis of tympanoplasty has been well discussed in terms of hearing outcomes and residual or recurrent lesions. Postoperative dizziness and vertigo are major complications of tympanoplasty; however, few reports are available. We investigated each condition of cholesteatoma postoperative vestibular risk using the STAM system and staging published by EAONO/JOS, as well as findings on bony destruction. From April 2010 to March 2021, 156 patients (166 ears) with cholesteatoma who underwent primary microscopic tympanoplasty at our hospital were registered. Subjective vestibular symptoms were recorded the day after surgery. Postoperative vestibular symptoms were observed in 13.9% of subjects. All of them were stage II and had both attic and mastoid lesions. Attic ( p  &lt; .05) and mastoid ( p  &lt; .01) lesions were risk factors. Multivariate analysis showed that significant differences were found in past histories of vestibular symptoms ( p  &lt; .05) and exposure of the dura mater ( p  &lt; .01). In the exposed dura group, the length of the prominence of the lateral semicircular canal to the middle cranial fossa dura was significantly shorter than that of the non-exposed group ( p  &lt; .01). Narrow working space and downward operation may increase vestibular risk.

Examination of risk factors for postoperative vestibular symptoms in patients with cholesteatoma