A Study on Recurrence of Middle Ear Cholesteatoma after a Canal Wall Down Tympanoplasty with Soft-wall Reconstruction

Abstract

We performed revision tympanoplasty on 10 patients with recurrent cholesteatoma in the past two years between May 2011 and April 2013. Four of 10 patients with recurrent cholesteatoma were operated on using a canal wall down tympanoplasty with soft-wall reconstruction as the initial surgery. We report herein on two representative cases of recurrent cholesteatoma in whom a canal wall down tympanoplasty with soft-wall reconstruction was initially performed. In the first case, an 11-year-old female child had repeated mucopurulent otorrhea from her left ear one year after the second planned staged tympanoplasty. The canal wall down tympanoplasty with soft-wall reconstruction was performed as second surgery. Otoscopic finding revealed recurrent cholesteatoma from the attic to a part of the mastoid cavity, protruding through the scutum and posterior wall defect. CT of the temporal bone showed soft tissue from the attic to the mastoid cavity with a bone defect of scutum and posterior canal wall. We diagnosed recurrent cholesteatoma after the canal wall down tympanoplasty with soft-wall reconstruction, and performed revision surgery. In the second case, a 10-year-old male child was suffering from purulent otorrhea from his right ear approximately one year after a canal wall down tympanoplasty with soft-wall reconstruction. Otoscopic finding revealed recurrent cholesteatoma that had eroded the scutum to invade the attic. The bone defect extended from the attic to more than half of the posterior canal wall. CT showed soft tissue from the attic to the mastoid cavity with a balloon-like retraction of the posterior canal wall. Finally we performed revision surgery for a recurrent cholesteatoma which had occurred after soft-wall reconstruction of the posterior canal wall. We consider that the soft-wall reconstruction for the purpose of simplifying the surgical procedure should be avoided. We had better preserve the posterior canal wall as much as possible when operating on children. Furthermore, when operating on children the long-term prognoses must always be considered.