The procedures differ in postoperative meatal appearance, cleaning requirements, residual disease, activity limitations and hearing aid fitting.
Meatus and cavity care
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Canal wall up surgery leaves a normal-appearing meatus and does not require routine cleaning.
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Canal wall down surgery leaves a widely open meatus communicating with the mastoid. The mastoid cavity requires cleaning by a doctor once or twice a year.
Residual disease and further surgery
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Canal wall up procedures have a high rate of recurrent or residual cholesteatoma and require second look surgery after about six months to rule it out.
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Canal wall down procedures have a low rate of recurrence or residual disease and are described as safe; second look surgery is not required.
Swimming and auditory rehabilitation
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Swimming is allowed after canal wall up surgery. After canal wall down surgery, swimming is curtailed because it can cause mastoid cavity infection.
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A hearing aid is easy to wear after canal wall up surgery if needed.
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After canal wall down surgery, the large meatus and mastoid cavity can make hearing aid fitting difficult, and the cavity sometimes becomes infected.