Five years experience using the intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: preliminary report.

Abstract

AbstractMany advances have occurred in the treatment of acute suppurative inflammation of the middle ear; however, the problem of chronic otitis media with cholesteatoma still persists today. This paper deals with the author's experience over 5 years using the intact canal wall tympanoplasty with mastoidectomy treatment in chronic otitis media with particular emphasis on the treatment of cholesteatoma both in adults and children.From May 1, 1976 to May 1, 1981, 204 ears were operated on for chronic otitis media with the tympanoplasty with mastoidectomy technique. Of this group, 104 ears were operated on using the intact canal wall technique when there was cholesteatoma present. The major emphasis of this paper will be to evaluate those ears with cholesteatoma.The technique of the procedure used and modifications that have been made are outlined with particular reference as to why modifications were made as problems arose while observing this group of patients.The results of this study suggest that there is a greater incidence of recurrence of cholesteatoma using the intact canal wall technique in children than in adults. It is believed that this higher rate is due to ongoing eustachian tube difficulties present in children. It is also felt that the intact canal wall technique does provide a better chance of auditory functional rehabilitation than an open cavity ear procedure. The problem of residual cholesteatoma still exists using the intact canal wall procedure; however, the problem seems to be well taken care of using a planned two‐stage procedure. This is particularly necessary because two‐thirds of all residual cholesteatoma was found to be in the middle ear.The conclusions of the study suggest that a planned two‐stage intact canal wall tympanoplasty with mastoidectomy can accomplish the goals of cholesteatoma surgery, i.e., control of the disease and improved functional results. It is felt that, if cholesteatoma recurs in a child, the revision operation should be converted to a properly performed open cavity procedure. It was felt that the anatomic removal of the posterior bony canal wall in an open cavity procedure does not render an ear safe from further problems.