Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery 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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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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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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Choice of approach for revision surgery in cases with recurring chronic otitis media with cholesteatoma after the canal wall up procedure

Auris Nasus Larynx ◽

10.1016/j.anl.2010.07.001 ◽

2011 ◽

Vol 38 (2) ◽

pp. 190-195 ◽

Cited By ~ 10

Author(s):

Kyung Tae Park ◽

Jae-Jin Song ◽

Sung Joong Moon ◽

Jun Ho Lee ◽

Sun O Chang ◽

...

Keyword(s):

Otitis Media ◽

Revision Surgery ◽

Chronic Otitis Media ◽

Canal Wall ◽

Canal Wall Up

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Revision Surgery for Chronic Otitis Media: A Learning Experience

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700606 ◽

1998 ◽

Vol 107 (6) ◽

pp. 486-491 ◽

Cited By ~ 36

Author(s):

Jan E. Veldman ◽

W. Weibel Braunius

Keyword(s):

Otitis Media ◽

Revision Surgery ◽

Learning Experience ◽

Chronic Otitis Media ◽

Canal Wall ◽

Long Term Follow Up ◽

Surgical History ◽

History Of ◽

Canal Wall Down ◽

Residual Air

The objective of this study was to evaluate, during a long-term follow-up period, the results of revision surgery for chronic otitis media with or without cholesteatoma. Intact canal wall and canal wall down procedures were performed. The surgical history of every patient was assessed before the operation. A dry, relatively safe, and disease-free ear was created in 90% of the reoperated ears (N = 389). The recurrence rate of cholesteatoma was 5% for the total group. Reperforations of the tympanic membrane occurred in 10%, and persistent or recurrent otorrhea was present in 10% of cases. The functional hearing results were quite satisfactory. A residual air-bone gap of ≤30 dB was reached in 70.3% of the cases after revision tympanoplasty only (N = 41). Revision mastoidectomy with revision tympanoplasty as a one-stage procedure led subsequently, in 76% of intact canal wall procedures (N = 113) and 55% of canal wall down procedures (N = 98), to a residual air-bone gap of ≤30 dB.

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Mastoidectomy: retrospective analysis of 137 cases in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174662 ◽

2017 ◽

Vol 4 (1) ◽

pp. 93

Author(s):

Jaya Chrisanthus ◽

Shibu George

Keyword(s):

Tertiary Care ◽

Chronic Otitis Media ◽

Positive Association ◽

Type I ◽

Care Hospital ◽

Facial Canal ◽

Canal Wall ◽

College Hospital ◽

Canal Wall Down ◽

Canal Wall Up

Background: Mastoidectomy is a common otologic surgery and at times can be a lifesaving procedure. The aim of the study is to analyze surgical indications, operative parameters and per-operative findings encountered. Methods: This is a retrospective study done in patients who had undergone mastoid surgeries between 1st Jan 2016 to 31st Dec 2016 in the Department of Otorhinolaryngology, Govt. Medical College hospital, Trivandrum. Results: Of the 137 patients the peak age incidence was 16 – 30 years. Cholesteatoma was present in 32% of which 91% had canal wall down mastoidectomy. 64% patients, mostly chronic otitis media- mucosal and inactive squamosal, underwent canal wall up procedure. In 62% cases the ossicular chain was eroded, which was mainly incus (87%). Abnormalities encountered within the mastoid during surgery were mainly dehiscent facial canal (17.5%), low lying dura (16.8%) and contracted antrum (15.3%). A positive association could be noted between contracted antrum and the position of sinus and dural plates, and was statistically significant. Co-existence of facial canal dehiscence with lateral canal fistula and dural plate dehiscence were also noted. The tympanoplasty procedures commonly employed in canal wall up procedures was Type I and 2, and in canal wall down procedure was Type 3. Conclusions: Adequate skill development of the ear surgeons in the tertiary centre should be ensured, to individualize the procedure appropriate for each patient and optimize the outcome of surgery. Early referral to the nearby otological centre should be promoted not only to prevent complications but also for better post-surgical functional outcome.

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Surgical Outcomes of Revision Operation for Non-Cholesteatomatous Chronic Otitis Media

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2019.00878 ◽

2021 ◽

Vol 64 (5) ◽

pp. 304-309

Author(s):

Juho Han ◽

Jisoo Lee ◽

Sung Kwang Hong ◽

Hyo Jeong Lee ◽

Hyung-Jong Kim

Keyword(s):

Otitis Media ◽

Surgical Outcomes ◽

Chronic Otitis Media ◽

Surgical Approaches ◽

Middle Ear Surgery ◽

Canal Wall ◽

Revision Operation ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Better Than

Background and Objectives The aim of this study was to investigate the surgical outcomes of revision operation due to recurrence of non-cholesteatomatous chronic otitis media (COM) surgery cases.Subjects and Method From 1989 to 2018, 5197 cases of COM surgery were performed at Kangdong and Hallym University Sacred Heart Hospital. Among them, clinical data of 297 subjects who had undergone revision tympanoplasty and/or mastoidectomy for recurrent noncholesteatomatous COM were retrospectively collected from computerized database of middle ear surgery (Korean Otological Society program 2005). Each case was categorized by surgical approaches into canal wall down mastoidectomy (CWDM), canal wall up mastoidectomy (CWUM), or tympanoplasty only groups.Results Tympanoplasty only was performed in 170 cases, CWDM in 74 cases, and CMUM in 53 cases. Postoperative perforation occurred in 9.4% of total cases, and less frequently in CMDM compared with tympanoplasty only (p=0.023), and CMUM (p=0.049), respectively, whereas no differences between tympanoplasty only and CMUM (p=0.930) were found. Postoperative infection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% of total cases, and the success rate of tympanoplasty only was better than that of CMDM (p=0.001), and CMUM (p=0.011). And, that of CMUM was better than that of CMDM (p=0.011).Conclusion The results showed that postoperative perforation occurred less frequently in CMDM than in tympanoplasty only and in CWUM; successful hearing was achieved more frequently in tympanoplasty alone than in the other surgical approaches in recurrent non-cholesteatomatous COM.

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