Audiometric Results of Open Cavity Tympanomastoidectomy in Advanced Attic Cholesteatoma

Abstract

In this retrospective study, we evaluated the audiometric results after using the retrograde mastoidectomy technique with open mastoid cavity for the removal of extended attic cholesteatomas. The described technique was used for cholesteatoma removal in 168 adult patients with an average follow-up time of 12 months. Due to cholesteatoma extension far into the mastoid, the disease was eradicated by the canal wall down (CWD) technique with the creation of an open mastoid cavity. Primary surgery was carried out in 47% of ears, with the remaining 53% representing revision surgery. In all cases, a classical CWD with an open mastoid cavity and partial obliteration with cartilage was created. A dry ear was achieved in 94% of cases. A postoperative air-bone gap ≤20 dB was achieved in 42.9% of the operated ears. 9.3% (n = 15) of the operated ears showed a postoperative air-bone gap >30 dB. Important factors leading to significantly better hearing restoration were an intact malleus, the use of alloplastic titanium prostheses and primary surgery. Although most cholesteatomas nowadays can be eradicated with the canal wall up technique, in far advanced cholesteatomas, the CWD technique can be applied with acceptable postoperative hearing results.

Long-Term Outcomes after Performing Tympanoplasty without Mastoidectomy for Active and Inactive Noncholesteatomatous Chronic Otitis Media

“…The technique of retrograde mastoidectomy is widely used to remove the lesion in the middle ear. Both the canal wall up and the canal wall down technique can be applied with acceptable audiometric results [6]. Although the mastoid and tympanic antrum seem to be filled with lesions as shown by high-resolution computerized tomography (HRCT) and magnetic resonance (MR) imaging, the available literature supports the notion that therapeutic mastoidectomy does not have any additional benefits for the management of noncholesteatomatous COM [3,[7][8][9][10].…”

Evaluation of Type III Tympanoplasty Using Cartilage Ossiculoplasty in Cholesteatoma Ear Surgery

“…[5][6][7][8] We performed an in-depth analysis of the sparse literature on the subject of hearing reconstruction in cholesteatoma. 4,5,[9][10][11][12] These studies have variable parameters. Most of these studies are retrospective analyses, which include both canal wall up and down surgeries and have used many types of prosthesis such as cartilage, autologous remnant ossicles, and biomaterials.…”

The role of autologous conchal cartilage in ossiculoplasty during canal wall down mastoidectomy

“…12 Use of titanium prosthesis for ossicular reconstruction provides good hearing results. 13,14 In developing countries the usage of autologous graft is more feasible instead of the costlier synthetic graft. The hearing results with autologous graft are similar to that of synthetic graft.…”