Canal Wall Up Research Articles

Results in resident cholesteatoma surgery: a review of 85 cases.

A review of all patients with cholesteatoma operated on by the residents of the New York Eye and Ear Infirmary under the attending supervision of the Otology Service between 1980 and 1984 was done. Of 130 resident cases, 85 had documented follow-up 1 year or longer and were included in the study. Recurrence rates were 18% with canal wall down (CWD) and 43% with canal wall up (CWU) techniques. Considering other forms of failure (such as precholesteatoma, tympanic membrane perforation, and chronic infection), overall failure rates were 33% (CWD) compared with 82% (CWU). Cholesteatoma recurrence failure rates were higher in patients under the age of 20 (33%) than over the age of 20 (19%). Overall failure rates were 61% and 37% for younger and older patients, respectively. Due to the high failure rate with canal wall up techniques in resident hands, it is recommended that resident service cases be treated with canal wall down technique, especially in the younger age group.

Surgical treatment of chronic middle ear disease. II. Canal wall up and canal wall down procedures.

Results of canal wall up (CWU) and canal wall down (CWD) tympanomastoid one-stage surgery were evaluated in 268 ears. In the CWU group of 121 ears, 50 ears (41%) had clinical cholesteatoma, whereas cholesteatoma was present in all 147 ears operated upon by the CWD technique. The disease was much less severe in the former group, which, for instance, showed no labyrith fistula, as compared with 17 (12%) in the latter group. Extensive disease also accounts for the larger number of complications seen in the CWD group. Average hearing levels postoperatively in the CWU group were significantly better than preoperatively. In the CWD group the preoperative levels were maintained. Recurrence of cholesteatoma was noted in 2% in the CWD group, while one implantation cholesteatoma occurred in the CWU group. Of the many surgical procedures available, the one offering the best means of curing the disease should of course be chosen. Ossicular repair with bone offers good prospects of a successful one-stage reconstruction.