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The canal wall down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma. Focus on recurrence and postoperative middle ear status

Presenting Author: Tomoyasu Tachibana

Published online by Cambridge University Press:  03 June 2016

Tomoyasu Tachibana ,
Michihiro Nakada ,
Yorihisa Orita  and
Kazunori Nishizaki
Tomoyasu Tachibana
Affiliation:
Himeji Red Cross Hospital
Michihiro Nakada
Affiliation:
Nakada ENT Clinic
Yorihisa Orita
Affiliation:
Okayama University
Kazunori Nishizaki
Affiliation:
Okayama University
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Abstract

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Learning Objectives:

Introduction: The aim of procedures performed for acquired cholesteatoma (AC) is the complete removal of lesions, the prevention of disease recidivism, and the restoration of hearing loss. Although two main surgical procedures are canal wall up and canal wall down tympanoplasty (CWDT), it remains controversial which procedure would be appropriate for AC.

Objectives: To review surgical results of CWDT with soft posterior meatal wall reconstruction (SWR) for AC and to identify factors associated with surgical outcomes.

Methods: A retrospective review was made of 119 (flaccida, 99; tensa, 20) ears with AC who underwent CWDT with SWR at Himeji Red Cross Hospital between 2002 and 2015. The mean age was 45 years. The mean postoperative follow-up was 65 months (range, 12 to 156 months). Analyzed factors included sex, age, the type and extent of AC, the type of ossiculoplasty, and so on. We defined postoperative balloon-like retraction (PBR) with web formation, which needed reoperation to clean accumulated earwax, as ‘nearly’ recurrence. We classified all cholesteatetomas according to JOS staging system for middle ear cholesteatoma (2015).

Results: Stage I and II were 24 and 95 ears, respectively. Residual was found in 11 ears (9.2%). Of 44 ears with PBR with web formation, 7 ears (5.9%) showed nearly recurrence. Seven residual and 4 nearly recurrent ears underwent outpatient operation, and the other 7 were operated on under general anesthesia. No significant factors associated with residual or nearly recurrence were evident. In multivariate analysis, the proportion of postoperative mastoid aeration was significantly higher among cases with age

Conclusions: CWDT with SWR showed a low recurrence rate. More than half of residual and nearly recurrent ears could be easily treated with outpatient intervention. This procedure seems to be fully acceptable for surgical treatment of AC.