Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: Long-term hearing outcomes

Objective: To report the long-term results of epitympanoplasty with mastoid obliteration technique. Subjects and Methods: Two hundred adult cases had undergone epitympanoplasty with mastoid obliteration from December 1994 to May 2003. The mean postoperative observation period was 91 months, with a minimum of five years. Epitympanoplasty with mastoid obliteration technique has four major procedures: the widening of the external auditory canal and removal of the scutum; preservation of the posterior canal wall; epitympanoplasty; and mastoid obliteration. We examined postoperative complications and hearing outcomes. Results: There was no retraction pocket formation and recurrence of cholesteatoma. Residual cholesteatoma in the tympanic cavity was seen in 10 cases (5%) and three cases were seen in the mastoid cavity (1.5%). Other complications were otorrhea (15 cases), perforation (8 cases), material extrusion (6 cases), and posterior auricular infection (4 cases). The average preoperative pure tone air-bone gap, postoperative pure tone air-bone gap, and air-bone gap closure were 31.5 ± 12.4 dB, 25.3 ± 12.2 dB, and 6.2 ± 12.6 dB, respectively. There were significant differences between the preoperative and postoperative values ( P < 0.01). Conclusions: The authors believe that epitympanoplasty with mastoid obliteration technique can combine the advantages of canal wall down and canal wall up techniques while improving their shortcomings.

Download Full-text

Modified intact canal wall mastoidectomy — long term results in hearing and healing

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-008-0109-7 ◽

2008 ◽

Vol 60 (4) ◽

pp. 317-323 ◽

Cited By ~ 5

Author(s):

A. Mahadevaiah ◽

Bhavin Parikh

Keyword(s):

Long Term Results ◽

Canal Wall ◽

Intact Canal Wall Mastoidectomy

Download Full-text

Tensa retraction cholesteatoma: treatment and long-term results

The Journal of Laryngology & Otology ◽

10.1017/s0022215100108321 ◽

1989 ◽

Vol 103 (2) ◽

pp. 149-157 ◽

Cited By ~ 18

Author(s):

T. Lau ◽

M. Tos

Keyword(s):

Ossicular Chain ◽

Observation Time ◽

Long Term Results ◽

Mastoid Process ◽

Canal Wall ◽

Pars Tensa ◽

Results Of Treatment ◽

Acquired Cholesteatoma ◽

Canal Wall Down

AbstractTo obtain the best possible results of treatment of acquired cholesteatoma, we made a subdivision of cholesteatoma types into attic and pars tensa cholesteatomas, and subdivided the latter further into tensa retraction cholesteatoma and sinus cholesteatomas. Tensa retraction cholesteatoma is defined as arising from a retraction or perforation of the whole pars tensa, whereas sinus cholesteatoma is defined as arising from a retraction or perforation of the postero-superior part of the tensa. We present the long-term results obtained in tensa retraction cholesteatomas treated with one stage surgery from 1964 to 1980. Median observation time was 9 years, range 2 to 19 years. Sixty-one ears were treated without mastoidectomy, whereas 71 ears had canal wall-up mastoidectomy and 64 ears had canal wall-down mastoidectomy. The total recurrence rate was 13.3 per cent; 17 ears had residual cholesteatoma, and nine ears had recurrent cholesteatoma. The best results were obtained in ears with an intact ossicular chain where mastoidectomy was not performed. In 49 per cent of the cases, the cholesteatoma was confined to the tympanic cavity without reaching the aditus, antrum or mastoid process. About one-third to one-quarter of the ears had tympanoplasty only, with removal of the cholesteatoma through the ear canal.

Download Full-text

Canal wall cholesteatoma following canalplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004885 ◽

2009 ◽

Vol 123 (10) ◽

pp. 1174-1176 ◽

Cited By ~ 2

Author(s):

M Martinez Del Pero ◽

N Donnelly ◽

N Antoun ◽

P Axon

Keyword(s):

Late Complication ◽

Canal Wall ◽

Ear Canal ◽

Early Complications ◽

Cartilage Reconstruction ◽

Air Cells ◽

And Cartilage ◽

Mastoid Air Cells

AbstractIntroduction:Bony canalplasty is a common otological procedure performed to widen a narrow ear canal. The aim of this report is to describe two unusual patients who presented with a canal wall cholesteatoma many years after bony canalplasty.Cases:Two patients, aged 28 and 52 years, are presented. Both underwent canalplasty, 14 and 17 years before re-presenting with cholesteatoma evident through posterior canal wall defects. Both patients underwent exploration of the mastoid cavities and cartilage reconstruction of the canal walls. There was no recurrence at 24 and three month follow-up examinations (variously), hearing was preserved in both cases, and the patients suffered no early complications.Conclusions:The most frequent long-term complication of canalplasty is re-stenosis of the external auditory canal. The importance of sealing any inadvertently opened mastoid air cells, in order to avoid the late complication reported, is emphasised.

Download Full-text

Canal wall down mastoidectomy: A long term commitment to the outpatients?

BMC Ear Nose and Throat Disorders ◽

10.1186/1472-6815-3-1 ◽

2003 ◽

Vol 3 (1) ◽

Cited By ~ 12

Author(s):

Hisham S Khalil ◽

Paul C Windle-Taylor

Keyword(s):

Canal Wall ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy

Download Full-text

Long-Term Hearing Outcomes following Stereotactic Radiosurgery in Patients with Vestibular Schwannomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633430 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Peter Santa Maria ◽

Yangyang Shi ◽

Richard Gurgel ◽

Carleton Corrales ◽

Scott Soltys ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Vestibular Schwannomas ◽

Hearing Outcomes

Download Full-text

Surgical Results of Retrograde Mastoidectomy with Primary Reconstruction of the Ear Canal and Mastoid Cavity

BioMed Research International ◽

10.1155/2015/517035 ◽

2015 ◽

Vol 2015 ◽

pp. 1-12 ◽

Cited By ~ 6

Author(s):

Chao-Yin Kuo ◽

Bor-Rong Huang ◽

Hsin-Chien Chen ◽

Cheng-Ping Shih ◽

Wei-Kang Chang ◽

...

Keyword(s):

Adverse Events ◽

Mastoid Cavity ◽

Surgical Results ◽

Ear Canal ◽

Hearing Results ◽

Hearing Gain ◽

Before And After ◽

Hearing Outcomes ◽

The Impact

The aim of this study was to retrospectively review the long-term hearing results and the impact of mastoid exclusion/obliteration in patients with cholesteatoma (102 ears) who underwent retrograde tympanomastoidectomy and in whom bone chips/paté were applied as the sole materials during the procedure. In 79 ears, this was combined with ossiculoplasty in a single-stage procedure. In >71% of ears, the results of audiometric testing were monitored for more than 2 years. The results suggested there was a significant gain in hearing following surgery, with respect to the postoperative change in both air-conduction thresholds and air-bone gaps (P<0.001). Linear regression analyses of pure-tone averages at different frequencies, before and after surgery, demonstrated that patients benefitted from a postoperative hearing gain at low and middle frequencies, but their hearing often deteriorated at frequencies of 8000 Hz. As for the impact of the type of tympanoplasty on hearing outcomes, type III-interposition markedly increased hearing gain. The overall rate of postoperative adverse events was 8.8%. We conclude that reconstruction of the ear canal and mastoid via mastoid exclusion/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde mastoidectomy. It gives excellent surgical results and has fewer postoperative adverse events.

Download Full-text

Hearing Outcomes Following Type 3 Tympanoplasty With Stapes Columella Grafting in Canal Wall Down Mastoidectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419841400 ◽

2019 ◽

Vol 128 (8) ◽

pp. 736-741

Author(s):

C. Burton Wood ◽

Brendan P. O’Connell ◽

Anne C. Lowery ◽

Marc L. Bennett ◽

George B. Wanna

Keyword(s):

Care Center ◽

Cohort Analysis ◽

Tertiary Care ◽

Canal Wall ◽

Short Term ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Hearing Outcomes ◽

Type 3

Objectives: To analyze hearing outcomes following Type 3 tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and determine disease recurrence rates in patients undergoing this procedure. Methods: This retrospective cohort analysis examines patients undergoing Type 3 tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if they were found to have undergone the aforementioned procedure. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 6 months and 1 year postoperatively. Results: Nineteen patients met criteria for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 37% of cases, highlighting disease severity. Eighteen (95%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 26 ± 11 dB HL; 26% achieved an ABG <20 dB, and 58% achieved an ABG <30 dB. Fifteen had follow-up at least 1 year postoperatively (mean = 33 ± 16 months). At longer-term follow-up, mean ABG was 25 ± 10 dB HL; 33% achieved an ABG <20 dB, while 66% achieved an ABG <30 dB. Hearing remained stable over time ( P = .52). At date of last clinical follow-up, only 1 (5%) patient had undergone revision for recurrent disease. Conclusion: In some patients undergoing canal wall down mastoidectomy for advanced or recurrent cholesteatoma, Type 3 tympanoplasty with stapes columella grafting yields marginal hearing benefit. This type of reconstruction is a viable option in this challenging patient cohort, particularly as it is associated with low rates of revision surgery.

Download Full-text