Abstract
PurposeTo evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction.MethodsThis is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing.Results79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques.ConclusionWe show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.
Highlights
While obliteration techniques in the surgical management of cholesteatoma gain popularity [1], cholesteatoma surgery is still often performed using the traditional canal wall up (CWU) or canal wall down (CWD) approach without obliteration
The recurrent and residual cholesteatoma rates after CWD without obliteration are lower compared to CWU without obliteration [2, 3], the CWD technique carries several disadvantages caused by the loss of self-cleaning capacity of the ear such as chronical discharge and infection
Obliteration of the mastoid with posterior canal wall reconstruction was performed in 56 cases (70.9%) whilst no obliteration was performed in 23 cases (29.1%)
Summary
While obliteration techniques in the surgical management of cholesteatoma gain popularity [1], cholesteatoma surgery is still often performed using the traditional canal wall up (CWU) or canal wall down (CWD) approach without obliteration. In our tertiary referral center, obliteration of the mastoid with posterior canal wall reconstruction for the management of chronically discharging mastoid bowls was introduced in 2013 and gradually replaced the revision canal wall down mastoidectomy without obliteration and canal wall reconstruction. As these different approaches were performed by the same otologic surgeons, this cohort lends well for comparison of the surgical outcome of the two techniques. The aim of this study is to evaluate the surgical results of revision surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with posterior canal wall reconstruction
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