Learning Objectives: It might be enough to concentrated on making the pneumatized cavity in the tympanic cavity alone. Further studies with a larger sample size will be needed to confirm it.

Introduction: It is not completely clear whether the pneumatized antrum is critical for good hearing in patients operated on for acquired cholesteatoma with canal wall-down type III (-c or -i) tympanoplasty with soft-wall reconstruction (CWDT-SWR). We thus investigated the correlation of pneumatization of the antrum with hearing outcome.

Methods: Eligible patients were: (1) CWDT-SWR was performed for the past four years; (2) ossiculoplasty was performed by the present author; (3) > 1 year follow-up. Patients who had a past history of an otologic operation in another institution were excluded. Twenty-two patients (age, 37 ± 13 yr) fit within the above condition. CT-scan was performed every year after surgery, and antrum pneumatization was evaluated. Pre- and post-operative pure-tone averages (PTA) and average air-bone gaps (ABG) were analyzed. PTA was calculated as the mean of 0.5, 1, 2, and 4 kHz thresholds. ABG was determined from air conduction (AC) and bone conduction (BC) thresholds that were measured at the same time. Average ABG (AABG) was calculated as the mean of 1, 2, and 4 kHz thresholds. Variables were shown in mean ± SD. Hearing results were compared using Mann Whitney test.

Results: Twelve patients had the pneumatized antrum (P-Group) and 10 did not (non-P-Group). Following results were shown in P-Group and non-P-Group, respectively: (1) pre-operative PTA was 37 ± 8 and 40 ± 24 dB; (2) pre-operative AABG was 20 ± 8 and 18 ± 12 dB; (3) the change in PTA was 7 ± 12 and -1 ± 14 dB; (4) the change in AABG was 4 ± 13 and -2 ± 14 dB. The variables were not statistically different between two groups.

Conclusion: With this sample size, pneumatization of the antrum do not have an impact on hearing outcome statistically in patients operated with CWDT-STR.