Intact Canal Wall Technique Research Articles

Five years experience using the intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: preliminary report.

AbstractMany advances have occurred in the treatment of acute suppurative inflammation of the middle ear; however, the problem of chronic otitis media with cholesteatoma still persists today. This paper deals with the author's experience over 5 years using the intact canal wall tympanoplasty with mastoidectomy treatment in chronic otitis media with particular emphasis on the treatment of cholesteatoma both in adults and children.From May 1, 1976 to May 1, 1981, 204 ears were operated on for chronic otitis media with the tympanoplasty with mastoidectomy technique. Of this group, 104 ears were operated on using the intact canal wall technique when there was cholesteatoma present. The major emphasis of this paper will be to evaluate those ears with cholesteatoma.The technique of the procedure used and modifications that have been made are outlined with particular reference as to why modifications were made as problems arose while observing this group of patients.The results of this study suggest that there is a greater incidence of recurrence of cholesteatoma using the intact canal wall technique in children than in adults. It is believed that this higher rate is due to ongoing eustachian tube difficulties present in children. It is also felt that the intact canal wall technique does provide a better chance of auditory functional rehabilitation than an open cavity ear procedure. The problem of residual cholesteatoma still exists using the intact canal wall procedure; however, the problem seems to be well taken care of using a planned two‐stage procedure. This is particularly necessary because two‐thirds of all residual cholesteatoma was found to be in the middle ear.The conclusions of the study suggest that a planned two‐stage intact canal wall tympanoplasty with mastoidectomy can accomplish the goals of cholesteatoma surgery, i.e., control of the disease and improved functional results. It is felt that, if cholesteatoma recurs in a child, the revision operation should be converted to a properly performed open cavity procedure. It was felt that the anatomic removal of the posterior bony canal wall in an open cavity procedure does not render an ear safe from further problems.

CHOLESTEATOMA SURGERY AT THE OTOLOGIC MEDICAL GROUP

This article is based on our reports at the International Cholesteatoma Conference, in Tel Aviv, March 1981. Included are a review of the evolution of the intact canal wall technique at the Otologic Medical Group and a detailed review of the findings at planned and unplanned revisions. We are currently using the intact canal wall procedure in 75 percent of our surgical procedures for cholesteatoma and obliteration technique in 20 percent, and leaving the cavity exteriorized in 5 percent. Seventy-five percent of the procedures are staged. Planned revisions were indicated to obtain an ear free of disease and an ear with satisfactory hearing. Residual disease was suspected in half of the revisions but found in only one-fourth. The middle ear was more commonly involved than the epitympanum or mastoid. A satisfactory functional result was obtained in 80 percent. Unplanned revisions were indicated primarily because of an unsatisfactory hearing result. Recurrent cholesteatoma was the indication in only fifteen cases. Residual cholesteatoma was uncommon. The key factor in the understanding of the incidence of residual and recurrent disease, and the functional result, is an understanding of the surgeons' philosophy. Surgeons who vigorously pursue a good functional result in all cases face a dilemma, regardless of how they manage the mastoid. The more persistent they are, the more problems they may encounter. A planned two-stage procedure frequently will be necessary to accomplish the dual objectives of tympanoplasty surgery: an ear free of disease and an ear with a good functional result.

Cholesteatoma surgery: Management of the labyrinthine fistula—A report of 97 cases

Preoperative, operative and postoperative findings in 97 cases of labyrinthine fistula are presented. Most of these patients had had symptoms of chronic otitis media for 20 years or more and manifested some degree of sensorineural hearing impairment. Two-thirds had experienced dizziness. The fistula was limited to the lateral semicircular canal in 83 cases and involved the labyrinth more extensively in 14 instances. The intact canal wall technique was used in less than 60% and an open cavity technique in 25% of the cases. Severe or total sensorineural hearing impairment developed postoperatively in 8% of the lateral canal cases and in over half of the extensive fistula cases. Five percent had incapacitating dizziness for up to six months postoperatively. When a labyrinthine fistula is encountered in an only hearing ear we usually recommend a classical modified radical mastoidectomy. In other instances the procedure performed will vary with the status of the opposite ear, the extent of the fistula, the sensorineural function of the involved ear and the size of the mastoid.

A review of 50 cases of intracranial complications from otogenic infection between 1961 and 1977.

The records of 50 patients with intracranial complications of middle ear disease treated over the past 16 years have been reviewed. Virtually all the known intracranial consequences of middle ear infection have been encountered, and include cerebral abscess, cerebellar abscess, meningitis, lateral sinus thrombosis, otitic hydrocephalus and cortical thrombophlebitis. The clinical features, neurological signs and investigative data for each group have been compared and contrasted. Treatment in the past has consisted of radical and modified radical mastoidectomy. It is proposed that these techniques will continue to be preferred for the management of chronic otitis media in the presence of a condition as serious as an intracranial complication. It is concluded that with a quoted incidence of postoperative cholesteatoma as high as 40% intact canal wall techniques are not justified in these patients at present.

Intact canal wall tympanoplasty with mastoidectomy

The data of 20 cases on whom intact canal wall tympanoplasty was done is presented. Some of the important practical points regarding this technique have been high lighted. We should seek new and improved techniques in mastoid surgery to return the ear to the pre-diseased state. This can only be achieved by analysing our results and handicaps so as to progress and develop the technique needed to reach the goal. The intact canal wall technique has been found very satisfactory with its main advantage of eliminating the postoperative mastoid eavity and having a dry ear eventually.

The intact canal wall technique in management of aural cholesteatoma.

The intact canal wall technique in management of aural cholesteatoma.

Some problems of the intact canal wall technique in the management of aural cholesteatoma.

Some problems of the intact canal wall technique in the management of aural cholesteatoma.