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Indications and techniques in Canal Wall Up Mastoidectomy

Presenting Author: Enrico Piccirillo

Published online by Cambridge University Press:  03 June 2016

Enrico Piccirillo ,
Sampath Chandra Prasad Rao ,
Flavia D'Orazio  and
Mario Sanna
Enrico Piccirillo
Affiliation:
Gruppo Otologico
Sampath Chandra Prasad Rao
Affiliation:
Gruppo Otologico
Flavia D'Orazio
Affiliation:
Gruppo Otologico
Mario Sanna
Affiliation:
Gruppo Otologico
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Abstract

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Learning Objectives:

Objective: The aim of this study is to retrospectively analyse the functional and hearing outcomes of canal wall up mastoidectomy for cholesteatoma.

Materials & Methods: 252 patients who underwent canal wall up mastoidectomy for cholesteatoma were analysed. Charts were analysed for age of the patient, type of cholesteatoma, surgical procedures, hearing results, recurrence and follow up.

Results: 64% of the patients belonged to the pediatric population. 38% of the patients had a follow-up of at least five years. Of the patients who underwent two staged surgery, 46.1% had a residual lesion that was identified and excised during the second surgery. Over a five year follow-up period, there were 12.5% patients with recurrences, all belonging to the group in whom a residual cholesteatoma was identified during the second staged surgery. The rate of residual cholesteatoma tended to decrease as age increases. The type of cholesteatoma, acquired or congenital middle ear, were not statistically related to the incidence of residual cholesteatoma. Hearing analysis showed that hearing recovery was excellent with canal wall up procedures and remained stable over five years.

Conclusion: Surgery for cholesteatoma is especially challenging in a pediatric population because of the need for hearing preservation. Hence canal wall up mastoidectomy in a single or two stages should be the approach of choice in the pediatric population. Radiological follow-up by DWI is mandatory for more than 5 years as recurrences can be seen even after 5 years.