Revision surgery for canal wall down mastoidectomy: intra-operative findings and results

Abstract

Conclusion: Canal wall down mastoid surgery following multiple earlier surgical failures can be revised by a well-trained experienced surgeon. A dry and safe ear is obtainable in most patients, and hearing preservation is also possible. Objectives: To analyze the intra-operative findings in revision surgery for canal wall down (CWD) mastoidectomy and to ascertain the prognosis.Methods: A total of 76 revision mastoidectomies with tympanoplasties performed from March 2008 to May 2014 at the First Affiliated Hospital of Zhengzhou University in China were reviewed. The pre-operative, intra-operative, and post-operative data was recorded and analyzed. Results: The possible reason of previous surgical failures were confirmed by the operative findings, which included inadequate mastoidectomy or persistent air-cell disease (66/76 [86.8%]), recurrent or persistent cholesteatoma (44/76 [57.9%]), excessive opened cavity combined with complications (9/76 [11.8%]), and infected cavities (68/76 [89.5%]). In this study, disease control was achieved in 70 (92.1%) patients. Complications following previous surgery were modified by revision surgery. Hearing was significantly improved in the 54 cases with ossicular replacement prosthesis. After a mean follow-up of 22 months, the group of revision surgery with ossiculoplasty as a whole experienced a statistically significant hearing gain of 16.57 ± 11.96 dB (p < 0.05) at air conduction pure tone average (PTA).