Canal Wall Reconstruction Tympanomastoidectomy with Mastoid Obliteration: Outcomes in Smokers

Abstract

Objectives: (1) Describe the canal wall reconstruction with mastoid obliteration (CWR/MO) technique, (2) understand the benefits for eradication of cholesteatoma, and (3) assess for poorer outcomes in smokers. Methods: Retrospective study analyzing the results of CWR/MO in 82 adult subjects at a tertiary referral center between 2006 and 2013. Subjects were 19 to 79 years old (mean, 44 years) and underwent CWR/MO for either primary or recurrent cholesteatoma. Subjects were re-evaluated with a second look tympanoplasty at least 6 months later. Long-term follow up ranged from 6 to 96 months (mean, 33 months). Fisher’s exact test was employed for significance. Results: Twenty-one of 82 subjects (26%) had residual cholesteatoma on second look, including 10 of 29 smokers (34%) and 11 of 53 nonsmokers (21%) ( P = .19). Five subjects (6%) had a retraction pocket without cholesteatoma on second look, including 3 smokers (10%) and 2 nonsmokers (4%). Twelve subjects (15%) had recurrent cholesteatoma on long term follow up, including 6 smokers (21%) and 6 nonsmokers (11%) ( P = .33). Three subjects (4%) required a canal wall down (CWD) procedure at some point during the follow up period, including 1 smoker (3%) and 2 nonsmokers (4%) ( P = 1). Conclusion: CWR/MO is an alternative to CWD without creation of a mastoid bowl. A second look is recommended to eliminate any residual/recurrent disease. This technique resulted in an overall recurrence rate of 15%, comparable to the CWD technique. Despite a trend towards increased recurrent disease in smokers, this did not reach significance.