Learning Objectives: Safety and efficacy of mastoid obliteration with autologous bone.

Introduction: Canal wall down (CWD) mastoidectomy is credited to low cholesteatoma recidivism, however drainage and infection of the mastoid bowl is sometimes a complication of surgery. Obliteration with autologous bone of the mastoid cortex can avoid the disadvantages of the CWD approach by combining the benefits of a smaller cavity less prone to infections. The aim of the study was to compare anatomical and functional results of “non-obliterated CWD mastoidectomy” (NO) and “obliterated CWD mastoidectomy” (O).

Methods: Consecutive CWD mastoidectomy from 1994 to 2014 have been revaluated to analyze incidence of postoperative synechiae and recurrent infections of the mastoid bowl, retraction pocket and perforation of the neotympanum, recurrence of cholesteatoma, and hearing threshold change (more than 10 dB in average 0.5–3 kHz).

Results: The study group included 317 adult patients (149 males and 168 females). Mastoid obliteration was performed in 88 patients (28%). There were 217 primary surgeries and 100 treatments for a recurrence (33% NO and 27% O) (P = 0.3). The cholesteatoma involved the middle ear in 71 patients, 246 had also a mastoid extension (76% in NO and 81% in O) (P = 0.4).

Dry synechiae developed in 11% (25/229) of NO and 16% (14/88) of O (P = 0.2). Recurrent discharge were observed in 8% (18/229) of NO and 3% (3/88) of O (P = 0.1). Dry retractions developed in 14% (32/229) of NO and 11% (10/88) of O (P = 0.7). Perforations were observed in 2.5% (6/229) of NO and 3% (3/88) of O (P = 0.7). Cholesteatoma recurred in 2% (4/229) of the NO and in none of O (P = 0.6). Hearing threshold improvement was observed in 28% (59/214) of NO and in 61% (38/62) of O (P = 0.001), impairment was observed in 12% (26/214) of NO vs. 13% (8/62) of O (P = 0.9).

Conclusions: Postoperative complication and anatomical results were comparable between NO and O, while functional results were superior in O.