Canal wall up versus canal wall down mastoidectomy for acquired cholesteatoma; a systematic review on disease recurrence rates

Objectives: To see the hearing outcomes following Type III tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and find out the recurrence rates in patients undergoing this procedure. Methods: This prospective observational study includes 120 cases undergoing Type III tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2018 to 2020. 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: One hundred and twenty patients were included for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 20% of cases, highlighting disease severity. One hundred and two (85%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 25 ± 12 dB HL; 36% achieved an ABG <20 dB and thirteen had follow-up at least 1 year postoperatively (mean = 33 ± 16 months). At longer-term follow-up, mean ABG was 24 ± 11 dB HL. Hearing remained stable over time (P = .26). Conclusion: In some patients undergoing canal wall down mastoidectomy for advanced or recurrent cholesteatoma, Type III tympanoplasty with stapes columella grafting yields marginal hearing benefit. Bangladesh J Otorhinolaryngol 2021; 27(2): 145-151

Download Full-text

Acquired cholesteatoma in children: presentation, complications and management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182705 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1017

Author(s):

Prabhu Khavasi ◽

Karra Bhargavi ◽

Santosh P. Malashetti ◽

Yasha C.

Keyword(s):

Paediatric Population ◽

Surgical Approaches ◽

Management Technique ◽

High Recurrence Rate ◽

Canal Wall ◽

Management Of Complications ◽

Middle Ear Cholesteatoma ◽

Acquired Cholesteatoma ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy

Background: Acquired cholesteatoma in children is an aggressive disease due to its rapid growth and high recurrence rate. The objective of the study was to assess clinical features of cholesteatoma in children and evaluate our experience in the overall management of this disease.Methods: This is a retrospective study of 20 children aged 6-15 years operated on for acquired middle ear cholesteatoma from June 2016 to December 2017. An analysis was made about the clinical and operative findings, surgical approaches and the overall management of complications. The data were then compared with the relevant and available literature. Results: Majority of the children presented with complaints of otorrhoea (100%), decreased hearing (90%), otalgia (50%), complications (25%) and most of them (85%) were operated by canal wall down mastoidectomy technique (CWD).Conclusions:Canal wall down mastoidectomy is the optimal management technique for adequate exposure and removal of cholesteatoma in paediatric population.

Download Full-text

Acoustic Mechanisms

Otolaryngology ◽

10.1016/s0194-5998(98)70264-5 ◽

1998 ◽

Vol 118 (6) ◽

pp. 751-761 ◽

Cited By ~ 28

Author(s):

KENNETH R. WHITTEMORE ◽

SAUMIL N. MERCHANT ◽

JOHN J. ROSOWSKI

Keyword(s):

Middle Ear ◽

Sound Transmission ◽

Canal Wall ◽

Air Space ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Temporal Bones ◽

Head Neck ◽

Canal Wall Up ◽

Space Volume

The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall-up and canal wall-down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall-up procedures, canal wall-down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262-8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall-down procedure. We conclude that as long as the middle ear air space is aerated and has a volume greater than 0.7 ml, canal wall-down mastoidectomy should generally cause less than 10 dB changes in middle ear sound transmission relative to the canal wall-up procedure. (Otolaryngol Head Neck Surg 1998;118:751-61.)

Download Full-text

Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215119002408 ◽

2019 ◽

Vol 133 (12) ◽

pp. 1074-1078 ◽

Cited By ~ 1

Author(s):

M D Wilkie ◽

D Chudek ◽

C J Webb ◽

A Panarese ◽

G Banhegyi

Keyword(s):

Discharge Rate ◽

Recidivism Rate ◽

Canal Wall ◽

Chi Square ◽

Mastoid Obliteration ◽

Recidivism Rates ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Canal Wall Up ◽

Cholesteatoma Surgery

AbstractObjectiveThis study sought to compare disease recidivism rates between canal wall up mastoidectomy and a canal wall down with obliteration technique.MethodsPatients undergoing primary cholesteatoma surgery at our institution over a five-year period (2013–2017) using the aforementioned techniques were eligible for inclusion in the study. Rates of discharge and disease recidivism were analysed using chi-square statistics.ResultsA total of 104 ears (98 patients) were included. The mean follow-up period was 30 months (range, 12–52 months). A canal wall down with mastoid obliteration technique was performed in 55 cases and a canal wall up approach was performed in 49 cases. Disease recidivism rates were 7.3 per cent and 16.3 per cent in the canal wall down with mastoid obliteration and canal wall up groups respectively (p = 0.02), whilst discharge rates were similar (7.3 per cent and 10.2 per cent respectively).ConclusionOur direct comparative data suggest that canal wall down mastoidectomy with obliteration is superior to a canal wall up technique in primary cholesteatoma surgery, providing a lower recidivism rate combined with a low post-operative ear discharge rate.

Download Full-text

A comparative study of hearing outcomes in canal wall up versus canal wall down mastoidectomy in our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190491 ◽

2019 ◽

Vol 5 (2) ◽

pp. 472

Author(s):

Poornima S. Bhat ◽

G. Gandhi ◽

K. Pradheep

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Pure Tone Audiometry ◽

Canal Wall ◽

Hearing Gain ◽

Hearing Outcome ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Conductive Hearing ◽

Canal Wall Up

Background: COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Ossicular reconstruction is a surgical procedure which intends to improve the quality of hearing and life in such patients. Comparison of the outcomes will help to determine the merits or demerits of a particular procedure.Methods: The study was conducted in the Department of ENT, VIMS, Bellary during the period from December 2010 to May 2012. All the patients with CSOM with ossicular erosion suggested by conductive hearing loss more than 40dB were included in the study. A detailed history taking, thorough clinical examination was done for these patients. Before and after the procedure pure tone audiometry was done to assess the hearing outcome. Post operatively PTA was done in 6th week, 3rd month, 6th month follow up. Hearing improvement was analysed according to the type of procedure. The data collected was tabulated and subjected to statistical analysis. Results: This study compared the outcomes of hearing gain in canal wall up versus canal wall down mastoidectomy surgeries. Hearing gain was better in canal wall up mastoidectomy (18.36 dB) than canal wall down mastoidectomy surgeries.Conclusions: Hearing outcome was better in intact canal wall mastoidectomy than canal wall down mastoidectomy in our study.

Download Full-text

Endoscopic Management of Acquired Cholesteatoma

Otolaryngology ◽

10.1016/j.otohns.2008.05.179 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P55-P55 ◽

Cited By ~ 1

Author(s):

Gabriele Molteni ◽

Daniele Marchioni ◽

Francesco Mattioli ◽

Angelo Ghidini ◽

Matteo Alicandri-Ciufelli ◽

...

Keyword(s):

Residual Disease ◽

Endoscopic Management ◽

Operating Microscope ◽

Canal Wall ◽

Sinus Tympani ◽

Primary Surgery ◽

Acquired Cholesteatoma ◽

Canal Wall Down ◽

A Prospective Study ◽

Canal Wall Up

Objective The purpose of this study was to examine the utility of using an endoscope in cholesteatoma surgery and to demonstrate how it allows a reduction in the incidence of residual disease. Methods A prospective study. A total of 53 ears with acquired cholesteatoma (primary) were resected. 20 cases were resected using a canal wall up (CWU) technique, 6 cases using a canal wall down (CWD) technique, and in 27 cases a transcanal tympanotomyatticotomy was performed. All of the patients in our study group underwent an explorative and operative endoscopic ear surgery complementary to the operating microscope to uncover and remove residual cholesteatoma. Results In the primary surgery after completion of microscopic cleaning, the overall incidence of intraoperative residual disease detected with the endoscope was 37.5%. The sinus tympani was the most common site of intraoperative residuals, followed by the anterior epitympanic recess and protympanum. Out of the 20 CWU cases, 12 second-look endoscopies were performed. Two recurrences were identified, both in the sinus tympani. There were no significant complications associated with the 53 endoscopic procedures. Conclusions The endoscope allowed a better understanding of cholesteatoma and improved eradication of residual disease from hidden areas such as the anterior epitympanic recess, retrotympanum and hypotympanum not yet controllable by operating microscope.

Download Full-text

Hearing Outcomes According to the Types of Mastoidectomy: A Comparison between Canal Wall Up and Canal Wall Down Mastoidectomy

Clinical and Experimental Otorhinolaryngology ◽

10.3342/ceo.2010.3.4.203 ◽

2010 ◽

Vol 3 (4) ◽

pp. 203 ◽

Cited By ~ 19

Author(s):

Min-Beom Kim ◽

Jeesun Choi ◽

Jae Kwon Lee ◽

Ju-Yeon Park ◽

Hosuk Chu ◽

...

Keyword(s):

Canal Wall ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Hearing Outcomes ◽

Canal Wall Up

Download Full-text

Recidivism of childhood cholesteatoma and surgical techniques: a meta-analysis study

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00043-z ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Yasser Shewel ◽

Seddik Abdel Salam Tawfik ◽

Abdulla A. L. Aaref ◽

Noha Saleh

Keyword(s):

Odds Ratio ◽

Meta Analysis ◽

Single Stage ◽

Main Body ◽

Canal Wall ◽

Analysis Study ◽

Increased Risk ◽

Acquired Cholesteatoma ◽

Canal Wall Down ◽

Canal Wall Up

Abstract Background There is a debate in the literature about surgical management of childhood cholesteatoma. We aimed to conduct a meta-analysis study about the recidivism of acquired cholesteatoma in children after two primary surgical procedures, namely canal wall up (CWU) and canal wall down (CWD) mastoidectomy. Main body of the abstract A Medline search of English language literature on PubMed and Cochrane Collaboration from their dates of inception until August 2019 was conducted using the following search terms: “pediatric or child and Cholesteatoma Surgery”. Twenty-eight full-text papers fulfilled the selection criteria and were included in this meta-analysis This analysis showed an odd risk of 1.72 for recidivism of childhood cholesteatoma in single-stage canal wall up procedure relative to canal wall down procedures. The 95% confidence interval (CI) for the overall odds ratio was 1.27–2.34. The I2 statistic was 37%, representing low heterogeneity. Comparing the rate of recidivism before and after the year 2000 showed that there was still increased risk of recidivism in the canal wall up versus canal wall down mastoidectomy (the odds ratio was 1.87 and 1.57 respectively). Short conclusion Single-stage canal wall up mastoidectomy was significantly associated with a higher risk of cholesteatoma recidivism compared to canal wall down technique in children with acquired cholesteatoma

Download Full-text