Abstract
Objectives:The most frequently used surgical methods for treating cholesteatoma include canal wall up and canal wall down procedures. The objective of the study was to compare the hearing improvement among children with cholesteatoma who underwent canal wall up and canal wall down surgical management.Methods:The cross-sectional analytical study design was used. The study was conducted at the ENT Department of Nishtar Medical University & Hospital Multan from 15th June to 15th Nov 2020.. Forty six patients with cholesteatoma were enrolled in the study after taking informed consent. Inclusion and exclusion criteria were followed. The participants were categorized into two groups. Group-A was treated with canal wall-up surgery while Group-B was treated with canal wall down Mastoidectomy. A 12-month post-operative follow-up and the audiometry assessment were compared with pre-surgical values. Additionally, a COMOT-15 survey was administered to analyze self-perceived hearing functions. The Chi-square test was used for comparative analysis of the surgical outcome and hearing improvement among the two groups. P-value (p value<0.05) was considered statistically significant.Results:Forty six patients were included in the study with 23 participants in each group. Among 46, 26 were male and 20 were female. The pre and post-operative mean Pure-tone average values were significantly different in (Group-A) who underwent canal wall up Mastoidectomy (p<0.05) than in Group-B, who underwent canal wall down Mastoidectomy. Similarly, hearing sub-section responses of the COMOT-15 survey favored the Canal wall technique. However, the survey showed no significant differences in the mental health status of the two groups (p<0.05).Conclusion:Our data collected after a one-year follow-up of patients suggests canal wall up as a preferred technique for hearing improvement than canal wall down technique.
Highlights
Cholesteatomas are characterized as congenital or acquired destructive growth of the stratified squamous epithelium in the temporal bone.[1]
canal wall up (CWU) mastoidectomy was introduced to counter the limitations of canal wall down (CWD) mastoidectomy but later on, it was found that it results in a higher recurrence rate.[6]
Patients who matched the following criteria were excluded from the study: patients older than 13 years, those with bilateral disease and were guided to undergo variable surgical techniques in both ears, those who were having their revision surgery, the patients who had planned tympanoplasty without Mastoidectomy, and those with other comorbidities which might influence their quality of life and in turn produce bias in the study results were excluded
Summary
Cholesteatomas are characterized as congenital or acquired destructive growth of the stratified squamous epithelium in the temporal bone.[1]. Mastoidectomies are of two types: canal wall up (CWU) and canal wall down (CWD). In the latter technique, a cavity or mastoid bowl is created which usually fills up with earwax and requires frequent cleaning of the ear canal and water protection. In the CWD surgery architecture of the ear is slightly changed which might disturb the hearing ability to certain degrees.[5]. The rationale of the current study is based on the belief of the author to validate a surgical strategy with the better, long-term effect of hearing ability of the patients. The objective of the study was to compare the Hearing improvement among children with cholesteatoma who underwent canal wall up and canal wall down surgical management
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