Postoperative cholesteatoma in combined approach tympanoplasty

Intact Canal Wall Tympanomastoid Surgery: 10 Years Experience

“…In our series, the frequency of residual and recurrent disease in 16 cases (5.8%) and thus considerably lower than the frequency observed in the classic CAT [12][13][14][15][16][17]. Removal of the disease from tympanic sinus is safer and easier via transcanal route after otosclerosis drilling of posterosuperior bony annulus.…”

“…Removal of disease from the anterior attic through the cortical mastoidectomy and from the tympanic sinus through the posterior tympanotomy is complicated, especially under narrow anatomical conditions and the large frequency of residual cholesteatoma is therefore not surprising [10][11][12][13][14][15][16][17][18].…”

“…The patient is best served by a single operation rationally selected and meticulously executed. The canal up technique (Classic CAT) has met with considerable criticism because of the need for second look and two stage operation [14,15]. The planned two stage operations and 2nd look operations are a strain on the patient and give no guarantee that the late deterioration of the hearing will not occur [4].…”

“…Recurrent disease has occurred more frequently in classic ICW cases either due to retraction of tympanic membrane into the epitympanum and facial recess or due to reperforation of the tympanic membrane) [17]. Smyth [14] concluded that lack of support for the tympanic membrane graft, especially in its superior and postero superior parts, and the nearby meatal skin, predisposed to its collapse into the tympanum. He suggested two modifications to prevent the collapse of graft into the tympanum: (i) lining the tympanum with inert material such as silastic sheeting (ii) repair of sulcus defect with cartilage.…”

Algumas considerações sobre colesteatomas adquiridos pediátricos e adultos

“…We should bear in mind that the approach creates a cavity that will require careful and long medical follow up in addition to demanding general care for the whole life of the patient, characterizing a limiting factor for some sports such as swimming and scuba diving 85 . However, the wall down technique, when compared to the wall up technique, presents less incidence of residual cholesteatoma 86 , regardless of the fact that the rate varies a lot depending on the author [87][88][89][90][91][92] . In all studies, it is always higher among children (Charts 2 and 3, below, adapted from Darrouzet et al 79 ).…”