Mastoid cavity obliteration in treatment of middle ear cholesteatoma

Abstract

Objective: The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry and safe ear. The method of choice for management of cholesteatoma is the inside out or reverse mastoidectomy. If external auditory canal reconstruction after complete cholesteatoma removal is not possible, mastoid cavity obliteration techniques are recommended to reduce the size of the open mastoid cavity. The goal of our study is to evaluate the frequency of postoperative ear secretion and hearing situation in patients with mastoid cavity obliteration in treatment of middle ear cholesteatoma. Methods: Retrospective study of 155 patients with middle ear cholesteatoma were surgically treatment during 52 months from 01.06.2014 to 30.09.2018 in Hospital Trakia Park, Stara Zagora (Bulgaria) with canal wall reconstruction or mastoid cavity obliteration with cartilage, bone pate or bone replacement alloplastic materials. Results: After complete cholesteatoma removal we perform ear canal reconstruction in 51.61% of cases (80; n=155), and in others 41.94% of cases (65; n=155) we perform mastoid cavity obliteration. In our patient group we perform type I tympanoplasty in 36.77% (57; n=155), type III tympanoplasty in 46.45% (72; n=155), Secondlook operations in 14% (21, n = 155) and only in 5 cases we left the operating cavity open (3.23%; n=155). After mean follow-up period from 11.34 months (1÷48 months; SD 13.10 months) our frequency of postoperative ear secretion is 6.45% (10; n=155) and our cholesteatoma residual rate is 9.03% (14; n=155). Conclusion: Mastoid cavity obliteration procedures can prevent the development of postoperative retraction pockets by isolation the tympanic cavity from the attic and mastoid. This is a safe and effective technique for rehabilitation of mastoid cavities. Hearing results of this technique is variable according to the involvement of the middle ear ossicles, but with the possibility of fitting a hearing aids or middle ear implants.