To evaluate the long-term outcomes of our novel mastoidoplasty (MP) using demineralized bone matrix (DBM) and to compare its feasibility for hearing aid (HA) usage with conventional mastoid obliteration (MO) with inferiorly based periosteum. A total number of 112 patients undergoing canal wall down mastoidectomy (CWDM) with mastoid reconstruction by MO (n=58) or by MP (n=54) between 2012 and 2022 who were followed up for more than 2 years were included in this retrospective study. Long-term surgical outcomes and the feasibility for hearing aid usage were evaluated by comparing the results of the postoperative EAC diameters measured by temporal bone CT scan, and HA adoption rates between the MP and MO groups. The MP group demonstrated superior EAC stability and feasibility for postoperative HA usage compared with the MO group. The MP group showed smaller axial (8.13±3.24 vs. 9.04±2.42mm, P=0.012) and coronal (10.13±2.53 vs. 11.52±3.06mm, P=0.014) EAC diameters compared with the MO group, indicating a more feasible condition for canal-type hearing aid usage. Postoperative HA adoption rates were significantly higher in the MP group (60% vs. 42.3%), with shorter time to adoption (9.33±12.82 vs. 24.14±27.03mo, P=0.040) compared with the MO group. Compared with MO with periosteal flap, MP utilizing DBM showed better long-term outcomes of EAC reconstruction for hearing aid adoption with its smaller EAC sizes as well as a higher HA adoption rate. MP also resulted in a faster hearing rehabilitation with hearing aids compared with MO. We propose that MP should be considered for optimizing anatomic and functional outcomes in CWDM patients requiring further hearing rehabilitation with a hearing aid.

To determine whether transcanal surgery without mastoidectomy, canal wall up (CWU), canal wall down (CWD), or CWU mastoid obliteration (MO) surgery for pediatric cholesteatoma has a more favorable effect on middle ear pressure (MEP) homeostasis. Data from children having mastoid surgery for acquired cholesteatoma were collected prospectively. Tympanometric values of MEP were compared after transcanal, CWU, CWD, and MO surgery analyzing (i) a single measure per ear from last clinic visit, and (ii) linear mixed-effects modeling (LMEM) to control for multiple measures, surgeries, age, and cholesteatoma severity (EAONO-JOS stage). 742 surgeries on 471 ears and 2382 tympanograms were completed. At last visit, (average age 15.6 years [6.0-19.3]), Type a tympanograms were present in 80/173 (46%) of transcanal surgeries, 64/132 (48%) CWU, 15/32 (47%) CWD, and 11/25 (44%) MO (Chi-square, p = 0.19), but 185/209 (89%) contralateral ears without cholesteatoma (Chi-square: p = 1.08 × 10-7). Median MEP was -47 daPa (IQR: 133) after transcanal, -65 daPa (IQR: 156) after CWU, -90 daPa (IQR: 151) after CWD, and -31 daPa (IQR: 151) after MO surgery and (Kruskal-Wallis: p = 0.4) but 5 daPa (IQR: 45) in normal contralateral ears (Wilcoxon: p = 7.92 × 10-13). LMEM showed MEP was dependent on age (p = 6.3 × 10-7) but not type of mastoid surgery (p = 0.70) or EAONO-JOS stage (p = 0.51). MEP after surgery for pediatric cholesteatoma is similar after transcanal, CWU, CWD, or MO surgery and remains lower than normal. Hypotheses that propose beneficial effects of these different surgical approaches on MEP homeostasis are not supported, so should not be used to influence choice of surgical approach.

There is no gold standard for canal wall reconstruction following its removal in mastoid obliteration surgery. This review aims to provide insight into the current state of the art on canal wall reconstruction, highlighting both successes and ongoing issues. Literature review (PubMed, Embase) of recent (≤ 15years) articles describing mastoid obliteration surgery with canal wall reconstruction in cholesteatoma or radical cavity patients. The data extracted were the reconstruction techniques and surgical outcomes as procedure safety, cholesteatoma recurrence, postoperative complications of the canal wall, infection, otorrhea recurrence and hearing rehabilitation. From 1584 articles, 28 were selected, 19 addressing cholesteatoma and 9 radical cavities. The most reported techniques were temporary removal and replacement of the canal wall and reconstruction using bone chips or cartilage. Perioperative complications were infrequent. Cholesteatoma recurrence ranged from 0-29%, infection from 0-27%, and otorrhea recurrence from 0-29%. The presence of postoperative complications or deformities of the canal wall were reported in the majority of included studies, indicating variable success. Hearing outcomes were generally positive. Considerable heterogeneity and inconsistent reporting limited reliable comparison of techniques between the studies. This is the first review to specifically concentrate on ear canal reconstruction in mastoid obliteration. Despite generally successful outcomes, clinicians are still often faced with cholesteatoma recidivism and postoperative complications. The actual impact of the canal wall reconstruction technique on long-term outcomes remains unclear. More consistent reporting and prospective comparative research is needed to better understand the factors influencing success and improve care for cholesteatoma patients.

According to the joint consensus of the European Academy of Otology and Neurotology and the Japan Otological Society on middle ear cholesteatoma, stage II encompasses a broad range of disease extensions, leading to variability in treatment outcomes among individuals with this disease stage. Herein, we aimed to investigate the risk factors for recidivism in stage II pars flaccida (PF) cholesteatoma. Retrospective cohort study. University hospital. In total, 228 consecutive ears with stage II PF cholesteatoma were treated surgically and followed up for >12 months. Patients underwent transcanal atticotomy, canal wall up tympanoplasty, or canal wall down (CWD) tympanoplasty with or without mastoid obliteration (MO). Recidivism rates, assessed using the Kaplan-Meier method, correlated with potential risk factors, including age, number of sites involved, difficult access sites (S1: supratubal recess, S2: tympanic sinus), and surgical procedures. The recidivism rate was significantly higher in pediatric patients (42.8%) than in adults (6.1%). Furthermore, recidivism rates were greater in patients with 3 or more involved sites (16.5%), S1 involvement (27.9%), and procedures other than CWD+MO (24.5%) than those with 2 involved sites (3.0%), no S1 involvement (5.1%), and underwent CWD+MO (5.4%), respectively. Multivariate analysis identified the involvement of 3 or more sites (hazard ratio: 5.12) and procedures other than CWD+MO (hazard ratio: 6.49) as independent risk factors for recidivism. In stage II PF cholesteatoma, involvement of 3 or more sites was identified as a risk factor for recidivism. CWD+MO intervention may reduce the recidivism rate.

Objective: To describe a practical surgical approach for mastoid cavity obliteration and canal wall reconstruction using autologous bone dust and conchal cartilage applied either during primary canal wall up (CWU) surgery or in revision of prior canal wall down (CWD) mastoid cavities, with the aim of restoring a self-cleaning, waterproof ear that retained its natural acoustic resonance. Methods: The indications, surgical technique, and follow up and imaging surveillance were described, detailing patient selection, harvesting and application of autologous materials, and the key technical steps for cavity obliteration and posterior canal wall reconstruction. The importance of preserving the ear canal’s standing wave resonance (~2000–2500 Hz) for optimal hearing was emphasized. Postoperative monitoring with non-echo planar diffusion-weighted imaging (DWI) MRI was recommended at least 1.5 years after surgery to detect residual or recurrent cholesteatoma. Results: This technique was performed successfully in 88 patients (32 males and 56 females, aged 6–80 years) across four hospitals in Metro Manila from January 2020 to July 2025. All patients had unremarkable postoperative courses and healed within three months. Among the 67 who underwent DWI MRI after 18 months, two required revision mastoidectomies with mastoid obliteration for cholesteatoma recidivism—one with residual and one with recurrent disease. Conclusion: Mastoid obliteration and reconstruction using autologous bone dust and cartilage has proven to be a safe, effective and cost-efficient technique. It converts problematic open cavities into dry, self-cleaning ears suitable for swimming while preserving the acoustic benefits of a near-normal ear canal. Long-term follow-up with diffusion-weighted imaging (DWI) MRI is essential to ensure durable disease control.

This case report details a rare and severe presentation of refractory otomastoiditis caused by Mycobacterium abscessus in an immunocompetent pediatric patient who presented with a 1-month history of left ear pain, swelling, and fever unresponsive to antibiotics. Computed tomography imaging was suggestive of coalescent otomastoiditis, and she underwent urgent left mastoidectomy, subperiosteal abscess drainage, and myringotomy with tube insertion, followed by conventional antibiotic management. Despite these interventions, she remained symptomatic and cultures revealed M. abscessus 1 week later. Multidisciplinary management involved serial microdebridement and prolonged multidrug antimicrobial therapy with shared decision-making between otolaryngology, infectious diseases, and international experts. Pharmacological management was complicated by adverse effects including aminoglycoside-induced hearing loss, myelosuppression, and gastrointestinal intolerance requiring drug substitutions. Eighteen months after initial presentation, revision mastoidectomy, canaloplasty, mastoid obliteration, tympanoplasty, and ossiculoplasty were performed for the eradication of residual disease and reconstruction. At follow-up, there was no disease recurrence although left-sided moderate-to-severe mixed hearing loss persisted. This case highlights the importance of early recognition and coordinated medical-surgical interventions in atypical presentations of mastoiditis.

Objective:To compare long-term rates of cholesteatoma recidivism between cases undergoing tympanomastoidectomy with obliteration and without obliteration.Study design:Retrospective case-control.Setting:Tertiary referral center.Patients:Adults and older children with pars flaccida cholesteatoma.Intervention:Tympanomastoidectomy with or without obliteration of the epitympanum and mastoid.Main outcome measure:Recidivistic cholesteatoma (ie, residual and/or recurrent cholesteatoma) determined by otoscopy, revision surgery, or imaging.Methods:Retrospective chart review of pars flaccida cholesteatoma surgeries by a single surgeon between 2015 and 2023. Demographic, clinical, and surgical information, inclusive of cholesteatoma type and EAONO/JOS staging.Results:There were 60 cases with obliteration and 63 cases without obliteration that were similar in age, sex, hearing, and cholesteatoma type and stage. Cases with obliteration had statistically significantly lower rates of recurrent (5% vs. 17%, P=0.0447) and residual (3.3% vs. 16%, P=0.0303) cholesteatoma compared with those without obliteration. The overall rate of recidivistic disease was 23.8% in cases without obliteration and 6.8% in cases with obliteration (P=0.0116). Using Kaplan-Meier analysis, recidivistic cholesteatoma–free survival rates at 5 years for the obliteration and non-obliteration groups were 91% and 63%, respectively (P=0.0367, log-rank test). No other clinical or surgical factors influenced recidivism.Conclusions:Epitympanum and mastoid obliteration during CWU and CWD tympanomastoidectomy for pars flaccida cholesteatoma is associated with reduced rates of recurrent and residual disease when compared with cases without obliteration.

Background/Objectives: Mastoid obliteration (MO) after canal wall down (CWD) tympanoplasty for chronic otitis media with cholesteatoma (COMC) enables simultaneous surgical management of the pathology and shaping of a new external ear canal (EEC) that is similar to the natural one. The aim of the present work is to describe the results of a new MO technique that involves using homologous bone (HB) material and a Palva flap (“Cupeta technique”). Methods: A retrospective study was conducted on 12 patients undergoing MO for COMC, either during the same operation or in a second-time surgery after CWD. The surgical technique, patient demographics, audiometric data, the EEC volume, and clinical outcomes were analyzed. Results: The MO technique resulted in good outcomes in terms of healing at three months after surgery. Fewer clinical complications were observed compared with similar MO methods described in the literature. HB reabsorption was observed in two patients and was defined as only partial. Measurements of the EEC volume were normal in all patients. The preoperative and postoperative hearing thresholds were similar. Conclusions: Performing MO with the Cupeta technique after CWD is a suitable surgical management method for COMC and demonstrates good clinical postoperative results. We plan to conduct further studies with a longer follow-up and a larger group of patients in order to confirm our findings.

Mastoid obliteration with bone dust mixed with concentrated growth factor.

To present the outcomes of mastoid obliteration using S53P4 bioactive glass (BAG) for refractory chronic suppurative otitis media (CSOM) and compare these to mastoidectomy alone. Retrospective comparative cohort study. Single-center study. All cases that underwent a canal wall up (CWU) mastoidectomy between 2010 and 2022 for refractory CSOM. Inclusion criteria were refractory purulent otorrhea preoperatively as indicated by Merchant grade 2 or 3 despite conservative treatment for at least 6 months, at least 1 year of follow-up and mastoid involvement as indicated by subtotal or total opacification on the preoperative imaging. Patients with cholesteatoma were excluded. Mastoid obliteration using S53P4 BAG. Merchant grade 1-year postoperatively, incidence of revision surgery during follow-up, frequency of tympanic membrane perforations, ventilation tube need, and audiological outcomes. In total, 124 obliteration cases and 84 non-obliteration cases were included. At 1-year postoperatively, the dry ear rate was 116 of 124 (94%) in the obliteration cohort and 71 of 84 (85%) in the non-obliteration cohort (p = 0.02). Continuous discharge (merchant grade 3) was only observed in one non-obliteration case. During follow-up, revision surgery due to refractory otorrhea was necessary in none of the obliteration cases and 10 non-obliteration cases (p < 0.001). The frequency of tympanic membrane perforations, ventilation tube need, and audiological results were comparable between the two groups. Our study indicates that for refractory cases of CSOM, mastoid obliteration using BAG results in superior outcomes compared to mastoidectomy alone. It results in significantly less postoperative otorrhea and revision operations and should therefore be considered. 3.

Pseudomeningocele is a of cerebrospinal fluid filled, extracranial cystic collection resulting from a dural defect, which may occur congenitally, postoperatively, or after trauma. Post-traumatic pseudomeningocele is rare, particularly in the temporal bone region. We report a 37-year-old woman who presented with progressive hearing loss and intermittent otorrhea, two decades after head trauma. Otoscopy revealed a pulsatile cystic lesion in the right external auditory canal. Imaging showed a ~20 mm tegmen tympani defect with herniation into the tympanomastoid area. Surgical repair involved transmastoid excision of the sac and multilayer reconstruction of the tegmen defect with mastoid obliteration. This case emphasizes the need to consider skull base defects in patients with a history of head trauma and persistent otologic symptoms.

Background: Research and development of new surgical treatments for patients with chronic purulent otitis media are actively carried out in otosurgery as today there is no single generally accepted treatment. This is an urgent task in pediatric practice as hearing loss in children can lead to irreversible consequences for their development. Aim: To increase the treatment efficacy for children with chronic purulent otitis media with cholesteatoma by improving the mastoid obliteration method. Methods: From 2019 to 2024, 54 children with chronic purulent otitis media with cholesteatoma were reoperated at the Pediatric Purulent Surgery Department of Krasnoyarsk Interdistrict Children’s Hospital No. 4. In group 1, we used bone chips for mastoid obliteration; in group 2 we used bone chips, platelet-rich plasma, and plasma gel. All children underwent a comprehensive examination at admission and 1 year postoperatively. Results: In otomicroscopy and non-EPI DWl MSCT/MRI of the temporal bones at 1 year, recurrence of cholesteatoma was detected in 36% of patients in the group where the standard obliteration with bone chips was used. In the group where platelet-rich plasma and plasma gel were used in combination with bone chips, cholesteatoma was detected in 1 patient (4%). Conclusion: The technique is easy to use and safe. It was effective in patients with chronic purulent otitis media with cholesteatoma.

Paragangliomas of the middle ear (glomus tympanicum, GT) are commonly encountered neoplasms of the temporal bone. GT is a benign tumor of vascular origin, arising from the neural crest cells and located on the promontory. The treatment of choice is surgical excision of the lesion. Our aim was to describe the surgical and hearing outcomes in a cohort of patients with middle ear paragangliomas following resection. We retrospectively reviewed the data of patients with GT who were treated with a CO 2 laser from 2014 to 2021. Preoperative and postoperative audiometric outcomes, symptom evaluations, and otomicroscopic examinations were performed. The surgical approach was individualized for each patient based on tumor characteristics demonstrated on computed tomography. Three different approaches were used: (1) canal wall down, canal wall reconstruction, and mastoid obliteration (CWD, CWR, and MO) mastoidectomy; (2) canal wall up (CWU) mastoidectomy; and (3) endaural/transcanal. Three males and 12 females aged between 33 and 76 years (mean, 56 yr) were included. Complete removal was accomplished in all cases using a CO 2 laser with no recurrence or complications during the postoperative follow-up period.CWU mastoidectomy, CWD mastoidectomy with CWR/MO, and endaural/transcanal approaches were used in 5, 3, and 7 patients, respectively. A flexible 500-micron CO 2 laser fiber was employed at 3-4 watts on the continuous mode setting.Three patients underwent concurrent ossicular chain reconstruction along with CWD/CWR mastoidectomy owing to preoperative conductive hearing loss with an air-bone gap (ABG) of wider than 30 dB, resulting in postoperative ABG closure. In relation to the remaining patients, no statistically significant postoperative worsening of audiometric outcomes in Word Recognition Score, pure tone average, and speech recognition threshold were observed. The mean follow-up period was 12 months. We found that using a flexible CO 2 laser fiber and CWD mastoidectomy with canal wall reconstruction and mastoid obliteration are beneficial for managing these tumors.CO 2 lasers are safe and reliable for GT resection. The advantages of this modality include complete removal, low complication and recurrence rates, and minimum morbidity.

The main objective of this study was to compare the residual and recurrence rates in canal wall up, canal wall down, and canal wall down with reconstruction tympanoplasty for the treatment of cholesteatoma, considering the different filling materials used: no mastoid obliteration versus obliteration using Bone Pate versus obliteration using G45S5 (Glassbone®). This was a retrospective cohort study conducted at a single tertiary medical center. Patient who underwent canal wall up, canal wall down or canal wall down with reconstruction tympanoplasty for a cholesteatoma (primary, secondary, recurrent or residual), with or without mastoid obliteration, with Bone Pate or G45S5 between January 2007 and March 2023 were included. Patients with congenital cholesteatoma and with a follow-up less than 6 months or with any other type of surgery techniques were excluded. A hundred and eight (46%) surgeries were performed without any mastoid obliteration, 66 (28%) with Bone Pate obliteration and 62 (26%) with G45S5 obliteration with a total of 236 surgeries. Survival analysis revealed significantly better outcomes for the Bone Pate cohort compared to without obliteration cohort on the recurrence and recidivism rate (HR 0.26; p = 0.03 and HR 0.39; p = 0.01 respectively). However, none of the statistical analyses showed significant differences between the non-obliteration cohort and the G45S5 cohort. Our study highlights the benefits of Bone Pate obliteration in cholesteatoma surgery. However, it does not provide conclusive evidence on the effectiveness of G45S5 obliteration in preventing residual and recurrent cholesteatoma.

Concentrated growth factors promote epithelization in the mastoid obliteration after canal wall down mastoidectomy.

Background: The aim of this study was to analyse the results of the mastoid obliteration technique with sticky bone (SB) and compare them with those obtained using bioactive glass S53P4 (BAG). Methods: This prospective preliminary study comprised 28 adults who underwent canal wall down (CWD) surgery using two mastoid obliterative techniques: SB (n = 21) or BAG (n = 7). The SB group was treated with the patients' own bone dust and injectable platelet rich fibrin (IPRF) (n = 13%) or bone dust, IPRF, and additionally allogenic lyophilised demineralised bone (n = 9%). Results: Nine months after the surgery, in the SB group, retroauricular depression was observed in three (14%) patients, temporary retroauricular fistula in one (5%), and a conical and smooth external auditory canal (EAC) was achieved in 15 (71%). Mean EAC capacity was 0.6 mL higher than in the contralateral ear. In the SB group, the tympanic membrane (TM) of nineteen (91%) patients was fully healed, one (5%) had TM perforation, and one (5%) developed a retraction pocket. In the BAG group, retroauricular depression was observed in four (57%) patients, temporary retroauricular fistula was present in one (14%), and a conical and smooth EAC was achieved in five (71%). Mean EAC capacity was 0.3 mL higher than on the opposite side. In the BAG group, we stated six (86%) patients with fully healed TM and one (14%) with a retraction pocket. One cholesteatoma was found in the BAG group and two in SB, (14% vs. 10%). After 9 months, all patients in both groups achieved a dry and self-cleaning cavity. Conclusions: Mastoid obliteration in CWD surgery using SB or BAG allows for reconstruction of the conical shape of the EAC with a volume similar to that of a healthy ear. Both techniques seem to have a minimal risk of complications and result in a dry, self-cleaning cavity. Further studies concerning a larger series of cases are necessary to confirm the findings of this preliminary analysis.

Background: The aim of the study is to evaluate the incidence of recurrence of acquired cholesteatoma and functional outcomes in patients who underwent CWD tympanoplasty with cavity obliteration using an inferior-based musculoperiosteal flap. A comparison between children and adults was conducted. Methods: All surgeries performed by the same expert surgeon from 2016 to 2019 were considered for the study. Patients younger than 18 years old, operated on at Meyer's Children Hospital, formed group A. Patients older than eighteen, operated on at Santo Stefano Hospital, formed group B. Clinical, audiological, and radiological data were collected from medical records. The Air Bone Gap (ABG) was used to assess the audiological results, and outpatient evaluations were considered to detect cases of recurrence. Results: Group A and Group B are composed of 23 and 25 patients, respectively. The postoperative ABG is 30.7 dBHL in group A and 29.5 dBHL in group B. The rate of recurrence is 17.2% in children and 8% in adults. The recurrence of cholesteatoma occurred in five children (21.8%) after an average follow-up of 18 months and in three adults (12%) after an average follow-up of 24 months. Conclusion: The surgical approach to CCOM in children aims to be as conservative as possible. The greater extension of the pathology is correlated with a greater erosion of the ossicular chain. According to our experience, open tympanoplasty with the obliterative technique allows us to obtain good anatomical and audiological outcomes, both in adults and children.

Objective: To explore the effect of hydroxyapatite (HA) combined with concentrated growth factor (CGF) on the cavity filling during endoscopic mastoidectomy in patients with middle ear cholesteatoma. Methods: The data of patients with middle ear cholesteatoma who underwent endoscopic canal wall down (CWD) mastoidectomy and mastoid obliteration with hydroxyapatite in Huazhong University of Science and Technology Union Shenzhen Hospital from December 2017 to October 2023 were retrospectively analyzed. The patients were divided into observational group (HA+CGF) and control group (HA) according to whether CGF was used. The postoperative follow-up time was not less than 6 months.The otoendoscopy results of the two groups were collected, and the excretion incidence of hydroxyapatite bone powder exposure was observed. The degree of epithelialization of the mastoid cavity and the time required for complete epithelialization were compared between the two groups using a subjective epithelialization scoring scale at one month post-operation. Results: A total of 58 patients (36 males and 22 females) aged (39.4±13.4) years were collected, including 26 left ears and 32 right ears. There were 30 cases in HA group and 28 cases in HA+CGF group, respectively. No statistically differences in gender, location and age were detected between the two groups (all P>0.05). The excretion incidence of bone powder exposure was 3.4% (2/58), with 1 case in HA group and 1 case in HA+CGF group, respectively. The median (Q1, Q3) subjective epithelialization score at one month post-operation was 1 (1, 2) in the HA+CGF group and 2(1, 2) in the HA group, with no statistically significant difference between the two groups (P=0.032). The results of 60-day follow-up after otoendoscopy showed that the proportion of complete epithelialization was 74.1% (20/27) in HA+CGF group and 48.3% (14/29) in HA group, and there was a statistically significant difference between the two groups (P=0.048). Conclusion: HA combined with CGF has a better effect on the cavity filling during endoscopic mastoidectomy in patients with middle ear cholesteatoma.

Background The surgical management of chronic otitis media (COM) withsquamous disease is canal wall down mastoidectomy (CWDM). Canal wall down procedures require the obliteration of the newly formed cavity to mitigate complications. Soft tissue flaps, including Rambo flap, Hong Kong flap, Palva flap, and inferior-based fascio-periosteal flap, as well as autologous bone pâté, have been the most successful and commonly used materials for obliteration over the past two decades. Although each flap has its advantages, the Palva flap is considered superior, primarily because of its ease of use and the simplicity of its design. In this study, we intend to evaluate the effectiveness of mastoid obliteration using autologous bone pate with Palvaflap compared to Palvaflap (post-auricular fibro-periosteal soft tissue) in patients who underwent CWDM. Methods Sixty-two patients with COMwith squamous disease were included in the study. The patients underwent CWDM with tympanoplasty and meatoplasty, followed by cavity obliteration using two different methods: group A - obliteration with Palvaflap (post-auricular fibro-periosteal soft tissue) and group B - obliteration with Palvaflap and bone pate. The patients were evaluated for cavity problems on post-operative days 21, 30, 60, 90, and 180, based on a 10-point scale compiled from the literature. Results Our study found that the majority of patients had right-sided disease and were between 41 and 60 years of age. Five out of sixty-two (8.1%) patients developed cavity problems, three in group A (9.7%) and two in group B (6.5%). The incidence of cavity problems was almost the same in both groups. The cavity problems were as follows: vertigo (1/62, 1.6%), surgical site infection (2/62, 3.2%), and graft failure (2/62, 3.2%). However, there were no statistically significant differences (p-value: 0.62) between either of the obliteration methods in terms of mitigating cavity problems. Conclusion Post-auricular soft tissue and post-auricular soft tissue with autologous bone pate in the obliteration of the CWDM cavity provided similar results in terms of mitigating cavity problems.

Despite a lot of scientific advancements in otology, canal wall-down mastoidectomy is still considered to be the standard of care in the management of extensive cholesteatoma. To avoid large cavity related problems, mastoid obliteration has been described in the literature for many decades. Controversy prevails among otologists regarding the materials used for obliteration. This study aimed to evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement. Retrospective analysis was performed of all consecutive patients who underwent canal wall down mastoidectomies and primary mastoid obliteration with ready-to-use, self-setting hydroxyapatite bone cement. Minimum follow-up was 1 year. Primary Outcome measures include need for explantation and post-operative complications. Total of 26 patients were included in the study. Only one patient required complete explantation. All patients acquired dry cavities in the final follow-up. Few minor complications including external auditory canal granulations and post-aural wound dehiscence. There was no cholesteatoma recidivism. Ready-to-use, self-setting hydroxyapatite bone cement serves the purpose of mastoid obliteration. In addition, it is time efficient and requires less expertise. It has excellent outcomes in terms of cholesteatoma recidivism. We recommend further research in this area with a large cohort.