Learning Objectives: To inform about the results of the use of S53P4 bioactive glass for obliteration of the mastoid cavity in cholesteatoma surgery. To demonstrate the advantages and limitations of the technique.

Introduction: Mastoid obliteration has been reported to reduce the number of recurrences and improve the quality of life in both canal wall up (CWU) and canal wall down (CWD) procedures, in the treatment of cholestatoma. Confronted with a rather high recurrence rate after CWU surgery without obliteration, we implemented the use of S53P4 bioactive glass (BonAlive). Our choice was made due to the unlimited availability and the alleged antibacterial, osteoconductive and osteopromotive properties. Here we report on the safety and efficacy of the use of S53P4 as obliteration material in cholesteatoma surgery.

Methods: Retrospective cohort study carried out in a secondary referral center. All patients were treated for cholesteatoma with tympanomastoidectomy and mastoid cavity obliteration using S53P4 granules between 2012 and 2015. Main outcome measures were procedure safety, cholesteatoma recurrence, and functional outcome (hearing levels and incidence of otorrhea).

Results: One hundred eleven patients (111 ears) were included. Mean age was 36 years (range 7–80). Eighteen patients were treated with canal wall up tympanoplasty. Ninety-three patients underwent a canal wall down procedure. Mean follow-up was 12.6 months. No wound infections occurred. Cholesteatoma recurrence was 9% (CWU: 17%, primary CWD: 8%, revision CWD: 0%). A dry ear was achieved in 96% of patients. No cases of perceptive hearing loss were encountered. Preparing and implanting the S53P4 granules was technically feasible.

Conclusions: S53P4 bioactive glass granules are safe and easy to use as a filler material in mastoid obliteration. Obliteration of the mastoid cavity with S53P4 granules resulted in less recurrences as compared to our previous results without obliteration