Canal Wall‐up Tympanomastoidectomy: Recurrence Factors

Abstract

Objective: Canal wall-up tympanomastoidectomy is gaining popularity in the treatment for cholesteatoma. The choice remains controversial because of the significant recurrence rate of this disease. We aimed to analyze tympanomastoidectomy success rate, to establish eventual predictive factors for failure, and to evaluate the computed tomography (CT) scan’s value in this pathology. Method: We performed a retrospective cohort study regarding all patients submitted to tympanomastoidectomy for cholesteatoma at the otolaryngology department of Hospital São José, Lisbon, from January 1, 2005, to December 31, 2009. Clinical and demographic data were obtained from medical records. Results: One hundred nineteen patients were submitted to tympanomastoidectomy. In most cases, preoperative CT scans showed cholesteatoma in the attic (50%) and large extension of the disease (tegmen, semicircular or fallopian canal erosion in 51%), not always confirmed during surgery (75%). Sixty percent had a canal wall-down procedure. The overall postoperative air-bone gap was within 20 dB in 44%. Second-look surgery was performed in 24 patients: the overall recurrence rate was 23%, with conversion to canal wall-down procedure in 67%. Factors identified as related to failure: cholesteatoma in the sinus tympani (33%), scutum erosion (29%), and large extension of disease (40%). Conclusion: The recurrence rate was significant, despite the high percentage of canal wall-down procedures. Factors for failure remain uncertain and CT scans presented limited value in the diagnosis and evaluation of cholesteatoma, especially postoperatively. In the absence of better diagnostic procedures, we recommend second look surgery to control cholesteatoma’s recurrence.