Outcomes Following Modified Tympanomastoidectomy With Soft-wall Reconstruction

Doerfer, Karl W.; Friedland, David R.

doi:10.1097/mao.0000000000001944

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…Supplementing the recidivism rates, the frequency of CWD conversion at second look was utilized as a proxy to measure the relative extent of recidivistic disease. Although there was no statistically significant difference in CWD conversion between S-CWR (15.6%) and B-CWR (5.9%), our rates were similar to previously reported literature of S-CWR (12.8%) and B-CWR (2.5-4.0%) (13,15,16) Regarding audiometric outcomes in S-CWR versus B-CWR, there were no significant differences between the cohorts when measuring the change in PTA, ABG, SRT, and WRS pre-versus postoperatively. S-CWR demonstrated slight worsening in ABG by 1.55 dB on average following second-look ossiculoplasty, while B-CWR had slight improvement by 2.17 dB on average.…”

Section: Discussionsupporting

confidence: 90%

“…Overall recidivism rates in our cohorts were 21.2% in S-CWR and 21.1% in B-CWR. In only ME/mastoid recidivism, the rate for S-CWR was 17.3% and 18.4% in B-CWR, within the range of previously reported ME recidivism rates for CWR in the literature, ranging from 9.2% to 39% (8,10,11,13–16). Of note, our definition of recidivistic disease is more inclusive than that reported in other studies (e.g., including CT and/or MRI data).…”

Section: Discussionsupporting

confidence: 85%

“…This, however, was not the case with 18% occurrence in B-CWR and 19% in S-CWR. In comparison to existing literature, reported canal wall resorption rates were highly variable with S-CWR rates ranging from 47% to 75% and a single B-CWR study citing a 1% rate of resorption (8,10,14,16). This variability is likely secondary to the subjectivity of reporting canal wall resorption, where some may report any sign of EAC widening with posterior wall retraction while others may only report if the posterior wall appears completed resorbed, creating a pseudo-mastoid bowl.…”

Section: Discussionmentioning

confidence: 84%

“…This, however, was not the case with 18% occurrence in B-CWR and 19% in S-CWR. In comparison to existing literature, reported canal wall resorption rates were highly variable with S-CWR rates ranging from 47% to 75% and a single B-CWR study citing a 1% rate of resorption (8,10,14,16). This variability is likely secondary to the subjectivity of reporting canal wall 11) performed S-CWR with fascia followed by partial mastoid obliteration with bone pâté (leaving the attic unfilled); however, canal wall resorption/retraction numbers were not published.…”

Section: Discussionmentioning

confidence: 94%

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Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration

Vesole,

Doyle,

Sarkovics

et al. 2024

Otol Neurotol

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Objective To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma. Study Design Retrospective chart review. Setting Tertiary neurotologic referral center. Patients Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty. Intervention(s) Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration. Main Outcome Measure(s) Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates. Results Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, −2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03). Conclusions Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon’s choice in approach.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 84%

“…This, however, was not the case with 18% occurrence in B-CWR and 19% in S-CWR. In comparison to existing literature, reported canal wall resorption rates were highly variable with S-CWR rates ranging from 47% to 75% and a single B-CWR study citing a 1% rate of resorption (8,10,14,16). This variability is likely secondary to the subjectivity of reporting canal wall 11) performed S-CWR with fascia followed by partial mastoid obliteration with bone pâté (leaving the attic unfilled); however, canal wall resorption/retraction numbers were not published.…”

Section: Discussionmentioning

confidence: 94%

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Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration

Vesole,

Doyle,

Sarkovics

et al. 2024

Otol Neurotol

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“…Despite these factors, very promising results have been achieved. 11,12 In the present study, during the post-operative period, the patients achieved hearing results similar to those reported in the literature. One of the important issues in ear canal reconstruction is that detecting recurrent cholesteatoma is more difficult because a closed cavity has been created.…”

Section: Discussionsupporting

confidence: 89%

Reconstruction of ear canal wall with superior pedicled composite multi-fractured osteoperiosteal flap: a new technique and preliminary outcomes

et al. 2021

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Objective. This study evaluated the functional results of the superior pedicled composite multi-fractured osteoperiosteal flap technique. This method is a novel technique for the reconstruction of the external auditory canal. The study also examined the effect of the superior pedicled composite multi-fractured osteoperiosteal flap technique on patients' disease-related quality of life. Method. A total of 37 patients who underwent the superior pedicled composite multi-fractured osteoperiosteal flap technique were enrolled in the study. Their functional hearing results and disease-related quality of life scores were evaluated. Results. A significant improvement was observed in the patients' hearing scores at the postoperative sixth month relative to the pre-operative period, and the patients' disease-related quality of life increased significantly. Conclusion. The superior pedicled composite multi-fractured osteoperiosteal flap method can be safely used, especially in patients undergoing retrograde mastoidectomy because of limited cholesteatoma. This method contributes to improving patients' hearing levels and disease-related quality of life.

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The optimal surgical treatment for canal‐wall‐up mastoidectomy of external auditory canal cholesteatoma

Pan,

Gu,

Sun

et al. 2024

Eye & ENT Research

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PurposeTo explore the optimal surgical excision treatment for external auditory canal (EAC) cholesteatoma involving the posterior wall and partial mastoid process.MethodsThis study included 115 inpatients (152 ears) diagnosed with EAC cholesteatoma involving posterior wall and partial mastoid from April 2022 to April 2024. Each patient underwent a canal‐wall‐up mastoidectomy, canaloplasty, and tympanoplasty. Preoperative clinical symptoms and hearing were compared with postoperative outcomes during follow‐ups.ResultsAll patients achieved a dry‐ear status and remained relapse‐free over the 0.5–2 years' follow‐ups. The most salient improvements were observed in hearing loss, oltagia, and aural fullness after the surgical intervention.ConclusionFor EAC cholesteatoma with the posterior canal wall and partial mastoid invasion, canal‐wall‐up mastoidectomy with reconstruction of the posterior canal wall is preferable, provided there are no severely extensive cholesteatomas present in the mastoid.

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Outcomes Following Modified Tympanomastoidectomy With Soft-wall Reconstruction

Cited by 6 publications

References 37 publications

Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration

Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration

Reconstruction of ear canal wall with superior pedicled composite multi-fractured osteoperiosteal flap: a new technique and preliminary outcomes

The optimal surgical treatment for canal‐wall‐up mastoidectomy of external auditory canal cholesteatoma

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