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The results of obliteration technique in canal wall up and wall down tympanomastoidectomy in patients with acquired middle ear cholesteatoma

Presenting Author: Nune Nahapetyan

Published online by Cambridge University Press:  03 June 2016

Nune Nahapetyan ,
Artur Shukuryan ,
Hayastan Mesropyan  and
Alla Hambardzumyan
Nune Nahapetyan
Affiliation:
Yerevan State Medical University, “Astghik”Medical Center
Artur Shukuryan
Affiliation:
Yerevan State Medical University, “Erebuni” Medical Center
Hayastan Mesropyan
Affiliation:
Yerevan State Medical University, “Astghik” Medical Center
Alla Hambardzumyan
Affiliation:
Yerevan State Medical University, “Astghik” Medical Center
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Abstract

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Learning Objectives:

Introduction: The objective in the surgical management of acquired middle ear cholesteatoma is eradication of disease and the creation of a dry, safe ear. For reducing of incidence of frequent cleaning need after CWD, as well as for control of reretraction of tympanic membrane after CWU tympanomastoidectomy, mastoid obliteration is preferable for many otological surgeons.

Material and Methods: 50 patients (16 to 65 y.o.) with cholesteatoma have been observed in this work. 34 ears have extensive cholesteatoma with erosion of posterior bony wall of ear canal. In 12 patients cholesteatoma involves only epitympanum, in 4-hole tympanic cavity. Posterior canal wall erosion due to cholesteatoma was indentified as the primary indication for radical mastoidectomy. Most patients mentioned periodic, only 7 of them- persistent otorrhea. All patients had conductive to mixed hearing loss with ABG more than 25 dB. 34 patients were undergone CWD, 16 CWU tympanomastoidectomy with mastoid obliteration using of bone pate′ from the cortical layer of mastoid. Temporalis fascia has been used for tympanic membrane grafting and for covering of mastoid cavity filling with bone pate′. Tragal cartilage has been used in 27 patients for placement between the head of the stapes and fascia. In cases of cholesteatoma in the oval window area, ossiculoplasty is postponed for second look surgery.

Results: Among the 50 patients 42(84%) grafts healed. In 5(10%) patients cholesteatoma developed during 3 years after the surgery. In 3(6%) patients reperforation occurred without cholesteatoma.

Conclusion: The mastoidectomy with tympanic membrane grafting and mastoid obliteration provides eradication of disease, prevents reretraction of tympanic membrane in patients with middle ear cholesteatoma. The results of surgery are good basis for the second stage- ossiculoplasty with hearing improvement.