The aim of this study was to retrospectively review the long-term hearing results and the impact of mastoid exclusion/obliteration in patients with cholesteatoma (102 ears) who underwent retrograde tympanomastoidectomy and in whom bone chips/paté were applied as the sole materials during the procedure. In 79 ears, this was combined with ossiculoplasty in a single-stage procedure. In >71% of ears, the results of audiometric testing were monitored for more than 2 years. The results suggested there was a significant gain in hearing following surgery, with respect to the postoperative change in both air-conduction thresholds and air-bone gaps (P < 0.001). Linear regression analyses of pure-tone averages at different frequencies, before and after surgery, demonstrated that patients benefitted from a postoperative hearing gain at low and middle frequencies, but their hearing often deteriorated at frequencies of 8000 Hz. As for the impact of the type of tympanoplasty on hearing outcomes, type III-interposition markedly increased hearing gain. The overall rate of postoperative adverse events was 8.8%. We conclude that reconstruction of the ear canal and mastoid via mastoid exclusion/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde mastoidectomy. It gives excellent surgical results and has fewer postoperative adverse events.

W e report on a 54-year-old male with bilateral grade II microtia and unilateral aural stenosis. He had undergone ossiculoplasty to correct conductive hearing loss in the left ear 2 years earlier in our hospital. On this hospital admission, another ossicular reconstruction surgery was arranged to treat conductive hearing loss in his right ear. With the patient under local anesthesia, a postauricular incision 1.5 cm behind the postauricular crease was performed. Unexpectedly, following the skin incision, the descending portion of the facial nerve was found exposed during dissection of the subcutaneous soft tissue (Fig 1). Further tracking down to its proximal end revealed that the descending portion of the facial nerve came out from a junction in the underdeveloped tympanic ring and mastoid process, lacking any bony covering. This was demonstrated by three-dimensional computed tomography postoperatively (Fig 2). The patient had grade III facial paralysis postoperatively thereafter but regained his facial function 6 months later.

HJB is not a contraindication for middle ear surgery. Awareness of this pitfall may lessen the operation risk.