The Efficacy of Mastoid Obliteration in Patients Who Recieved Canal Wall Up Tympanomastoidectomy for Chronic Otitis Media

AbstractObjective:To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients.Methods:Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry.Results:The pre-operative mean air–bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air–bone gap values were significant.Conclusion:No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.

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Myringostapediopexy: surgical expectation

The Journal of Laryngology & Otology ◽

10.1258/002221503321192467 ◽

2003 ◽

Vol 117 (3) ◽

pp. 182-185

Author(s):

P. J. D. Dawes

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Hearing Level ◽

Canal Wall ◽

Similar Range ◽

Canal Wall Down ◽

Canal Wall Up

Myringostapediopexy may occur as a result of incus erosion with medialization of the tympanic membrane and is recognized as often producing serviceable hearing. The technique may be used as part of tympanoplasty following either canal wall up or canal wall down surgery for chronic otitis media. The use of this type of reconstruction is influenced by the anatomy of the ear after disease excision. This review of the hearing levels associated with myringostapediopexy shows that there is a similar range of hearing level both for naturally formed as well as surgically fashioned myringostapediopexy. For both ’naturally formed’ and following canal wall up surgery about 80 per cent of patients will have an air-bone gap of 20 dB or less compared to 60 per cent of those who undergo canal wall down surgery.

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Endoscopic epitympanic exploration in mucosal chronic otitis media: is canal wall up mastoidectomy really needed?

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000086 ◽

2021 ◽

Vol 135 (1) ◽

pp. 39-44

Author(s):

A Das ◽

S Mitra ◽

S Hazra ◽

A Sengupta

Keyword(s):

Otitis Media ◽

Operating Time ◽

Chronic Otitis Media ◽

Canal Wall ◽

Surgical Time ◽

Cortical Mastoidectomy ◽

Post Operative Pain ◽

Significant Difference ◽

Canal Wall Up

AbstractObjectiveTo compare endoscopic epitympanic exploration with conventional canal wall up (cortical) mastoidectomy for mucosal chronic otitis media in terms of post-operative outcomes.MethodsSeventy-six patients diagnosed with chronic otitis media (mucosal variety) were randomly assigned to two treatment groups: endoscopic epitympanic exploration and conventional canal wall up (cortical) mastoidectomy. The groups were compared in terms of: post-operative anatomical outcomes (graft uptake), middle-ear physiological outcomes (post-operative tympanometry), audiological outcomes (air–bone gap), surgical time, post-operative pain, vertigo, and long-term complications such as retraction pocket and re-perforation.ResultsThere was a statistically significant difference between the groups in terms of mean air–bone gap at 12 months, surgical time, and median post-operative pain measured at 6 hours (p < 0.05). No statistically significant differences were noted in terms of: graft uptake at 1, 3 and 6 months, mean air–bone gap at 3 and 6 months, tympanometry at 3, 6 and 12 months, vertigo at 1 week, or long-term complications.ConclusionEndoscopic epitympanic exploration resulted in significantly better long-term audiological outcomes, shorter operating time and less pain compared with conventional canal wall up (cortical) mastoidectomy.

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Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media

International Archives of Otorhinolaryngology ◽

10.7162/s1809-97772013000300002 ◽

2014 ◽

Vol 17 (03) ◽

pp. 242-245

Author(s):

Anna Soares ◽

Henrique Garchet ◽

Nicodemos Sousa ◽

Alexandre Azevedo

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Canal Wall ◽

Canal Wall Down ◽

Canal Wall Up

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Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

International Archives of Otorhinolaryngology ◽

10.1055/s-0036-1592417 ◽

2016 ◽

Vol 21 (03) ◽

pp. 239-242 ◽

Cited By ~ 2

Author(s):

Suphi Bulğurcu ◽

İlker Arslan ◽

Bünyamin Dikilitaş ◽

İbrahim Çukurova

Keyword(s):

Facial Nerve ◽

Otitis Media ◽

Chronic Otitis Media ◽

Semicircular Canals ◽

Ossicular Chain ◽

Facial Canal ◽

Canal Wall ◽

Radical Mastoidectomy ◽

Canal Wall Down ◽

Canal Wall Up

Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8–72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

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One-stage cochlear implantation in patients with chronic otitis media using canal wall up mastoidectomy

Acta Oto-Laryngologica ◽

10.1080/00016489.2021.1877812 ◽

2021 ◽

Vol 141 (4) ◽

pp. 354-358

Author(s):

Yeonsu Jeong ◽

Young Kyun Hur ◽

Jae Young Choi ◽

Sung Huhn Kim ◽

In Seok Moon ◽

...

Keyword(s):

Otitis Media ◽

Cochlear Implantation ◽

Chronic Otitis Media ◽

Canal Wall ◽

One Stage ◽

Canal Wall Up

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Functional outcomes of middle ear cholesteatoma surgery

Medicinski pregled ◽

10.2298/mpns1804109v ◽

2018 ◽

Vol 71 (3-4) ◽

pp. 109-113

Author(s):

Dalibor Vranjes ◽

Sanja Spiric ◽

Slobodan Spremo ◽

Dmitar Travar ◽

Predrag Spiric ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Lower Incidence ◽

Functional Outcomes ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Canal Wall ◽

Canal Wall Down ◽

Canal Wall Up

Introduction. Chronic otitis media is defined as a persistent inflammation of the middle ear with signs of an infection lasting for three months or longer. Chronic otitis media may occur either with or without cholesteatoma. For both types of conditions, surgical treatment with closed canal wall-up or open canal wall-down techniques of tympanoplasty are considered. Our aim was to evaluate functional outcomes in two groups of patients (chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma) treated with various tympanoplasty techniques. Material and Methods. This retrospective study included 100 patients who underwent canal wall-down and canal wall-up tympanoplasty for the treatment of chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma from 2015 to 2016. All study patients underwent routine clinical and audiometric examinations. The study evaluated preoperative and postoperative functional results (evaluation of pure-tone audiogram screening). Results. A statistically significant lower incidence (p < 0.05) of postoperative air-bone gap < 20 decibels was established in patients with chronic otitis media with cholesteatoma, but there were no statistically significant differences between the two groups. There was a statistically lower incidence (p < 0.05) of patients with postoperative pure tone audiometry < 40 decibels in patients with chronic otitis media with cholesteatoma, but the difference between the two groups was not statistically significant. When analyzing the mean postoperative pure tone audiometry and air-bone gap in the study patients, canal wall-up tympanoplasty was found to be statistically more effective (p < 0.05). Conclusion. Various pathomorphological and pathophysiological changes in the middle ear, presence of extensively different forms of cholesteatomas, the choice of surgical procedures and poor preoperative hearing are in direct correlation with postoperative hearing.

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Surgical management of only hearing ears with positive indications

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002556 ◽

2006 ◽

Vol 120 (11) ◽

pp. 972-975 ◽

Cited By ~ 3

Author(s):

M Sakagsami ◽

T Muto ◽

O Adachi ◽

Y Mishiro ◽

K Fukazawa

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Hearing Aid ◽

Chronic Otitis Media ◽

Canal Wall ◽

Surgical Indications ◽

The Past ◽

Canal Wall Down ◽

Canal Wall Up

Positive surgical indications for an only hearing ear were evaluated in order to improve patients' quality of life. Fifteen cases of surgery involving an only hearing ear over the past eight years were retrospectively reviewed. Of eight perforated chronic otitis media cases, seven underwent type one tympanoplasty and one underwent simple underlay myringoplasty regardless of otorrhoea at the time of surgery. Of six cholesteatoma cases, two received the canal wall up method and four received the canal wall down method. Ossiculoplasty was carefully performed in six cases. Hearing was improved in seven cases, whereas it remained unchanged in seven cases and deteriorated in one case. Of nine patients, two did not need a hearing aid after surgery. Five patients with severe combined hearing loss (>90 dB) were able to communicate with a hearing aid, alleviating their anxiety regarding hearing loss. Only hearing ears with chronic otitis media and cholesteatoma can be successfully treated by tympanoplasty with or without ossiculoplasty.

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