Long-Term Results of Canal Wall Reconstruction Tympanomastoidectomy

Walker, Paul C.; Mowry, Sarah E.; Hansen, Marlan R.; Gantz, Bruce J.

doi:10.1097/mao.0b013e3182a446da

Cited by 64 publications

(87 citation statements)

References 15 publications

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“…Walker et al [1] and Gantz et al [10] did not insert ventilation tubes. They mentioned the effect of poor ET function on the development of retraction pockets.…”

Section: Discussionmentioning

confidence: 99%

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Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years’ Experience in Fayoum Province, Egypt

Qotb

Fawzy²,

Ragab³

2017

Int Adv Otol

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OBJECTIVE:Removing the posterior canal wall or canal wall down mastoidectomy (CWDM) for the management of cholesteatoma remains controversial. We advocate partial removal of the posterior canal wall for complete eradication, followed by canal wall defect reconstruction to restore the normal anatomy and avoid the complications of CWDM. MATERIALS and METHODS:Sixty-four patients with cholesteatoma (71 ears) were included. This study was conducted between 2009 and 2012. Single-stage mastoidectomy was performed by drilling the upper third of the posterior canal wall together with the attic, leaving the remaining lower two-thirds intact. Conchal cartilage was used to reconstruct the upper third of the posterior canal wall. RESULTS:The mean±SD healing time was 7.5±2.3 (range, 4-14) weeks. The mean±SD preoperative and postoperative air bone gaps were 35.8±6.2 dB and 22.9±6.8 dB, respectively. Nearly 84.2% of the patients were followed up for at least 3 years and had dry healthy ears. Complications were noted and statistically examined. CONCLUSION:Single-stage CWDM with reconstruction of the posterior canal wall, ossicular chain, and tympanic membrane is a safe and reliable technique with the advantages of Canal wall up Mastoidectomy (CWUM). Its recurrence rate is 4.2%. Longer follow-up durations are required.

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“…Walker et al [1] and Gantz et al [10] did not insert ventilation tubes. They mentioned the effect of poor ET function on the development of retraction pockets.…”

Section: Discussionmentioning

confidence: 99%

“…The primary objective in the management is the complete eradication of the disease and creation of a safe ear [1] . Additional objectives include preservation of hearing and restoration of normal middle ear and external auditory canal morphologies for providing an improved quality of life [2] .…”

Section: Introductionmentioning

confidence: 99%

Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years’ Experience in Fayoum Province, Egypt

Qotb

Fawzy²,

Ragab³

2017

Int Adv Otol

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“…These techniques are more physiologic in nature in comparison to the canal wall down procedure, do not cause cavity problems, and have lower infection rates. However, these techniques have higher recurrence rates than the ca- nal wall down procedure, [9] which may be due to restrictions on the surgical field owing to poor exposure and dysfunction of the Eustachian tubes, which increase the risk of the postoperative formation of a retraction pocket in the pars flaccida [10] . In order to reduce the risk of recurrence, some researchers removed the posterior canal wall integrally, resected the cholesteatoma tissue completely, and then reconstructed the posterior canal wall and obliterated the attic and mastoid antrum [11] .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Posterior Canal Wall Reconstruction Using Autologous Auricular Cartilage and Bone Pâté in Chronic Otitis Media with Cholesteatoma

Baek

Choi²,

Kim³

et al. 2016

Int Adv Otol

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OBJECTIVE:This study was designed to investigate the long-term results using the technique of canal wall up mastoidectomy and reconstruction of the posterior canal wall using bone pâté and auricular cartilage in the treatment of chronic otitis media with cholesteatoma. MATERIALS and METHODS:A retrospective review was performed on 42 patients who underwent canal wall up mastoidectomy and posterior canal wall reconstruction at a single institution between November 2005 and November 2012. RESULTS:Of the 42 patients, postoperative tympanic membranes were normal in 38 (90.5%), perforated in 1 (2.4%), and retracted in 3 (7.1%). Mean preoperative and postoperative values of the air-bone gap (ABG) were 29.4±12.8 and 23.4±11.7 dB, respectively, which represented a significant average improvement. For patients with ossiculoplasty (n=24), the mean preoperative and postoperative ABG values were 34.7±6.0 and 27.5±8.0 dB, respectively, which also represented a significant average improvement. Thirty-one (73.8%) of the patients were followed up without any complication, but 5 had otorrhea (11.9%), 4 had dizziness (9.5%), and 2 had facial palsy (4.8%). CONCLUSION:A canal wall up mastoidectomy with reconstruction of the posterior canal wall using auricular cartilage and bone pâté provides successful preservation of the anatomic structure and a significant improvement in hearing without the long-term disadvantages of a canal wall down mastoidectomy.

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“…187 Mastoid obliteration with 1-stage eradication of the disease and a total reconstruction procedure provide long-term hearing improvement with a low incidence of persistent or recurrent disease in adults and children. [195][196][197][198][199][200][201][202][203] A quality-oflife study 204 conducted on patients with cholesteatoma who underwent mastoidectomy and mastoid obliteration with autologous cranial bone graft indicated a significant quality-oflife benefit from the procedure. Csakanyi et al 205 constructed a mathematical model that predicted that mastoid obliteration can improve ME gas pressure balance, resulting in better long-term outcome in MEs with poor mastoid pneumatization and ETD.…”

Section: Physiology and Pathophysiologymentioning

confidence: 99%

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid—Anatomy, Physiology, Pathophysiology, and Pathogenesis)

Alper

Luntz

Takahashi

et al. 2017

Otolaryngol.--head neck surg.

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Objective. In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research.Data Sources. PubMed, Web of Science, Medline.Review Methods. The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed.Conclusions. Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction.Implications for Practice. In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.

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Long-Term Results of Canal Wall Reconstruction Tympanomastoidectomy

Abstract: 4.

Cited by 64 publications

References 15 publications

Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years’ Experience in Fayoum Province, Egypt

Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years’ Experience in Fayoum Province, Egypt

Efficacy of Posterior Canal Wall Reconstruction Using Autologous Auricular Cartilage and Bone Pâté in Chronic Otitis Media with Cholesteatoma

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid—Anatomy, Physiology, Pathophysiology, and Pathogenesis)

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