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Canal wall up versus canal wall down mastoidectomy for acquired cholesteatoma; a systematic review on disease recurrence rates

Presenting Author: Jef Mulder

Published online by Cambridge University Press:  03 June 2016

Jef Mulder ,
Franco Abes  and
Casper Tax
Jef Mulder
Affiliation:
Radboud University Medical Center
Franco Abes
Affiliation:
University of Santo Tomas Hospital, Manilla, Philippines
Casper Tax
Affiliation:
Radboud University Medical Center
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Abstract

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Learning Objectives: The aim of this study is to compare the proportion of disease recurrences in patients with acquired cholesteatoma, 5 years after Canal Wall Up or Canal Wall Down mastoidectomy.

Introduction: Cholesteatoma is a destructive ear disease. Therapy consists of surgical removal by mainly the canal wall down (CWD) or canal wall up (CWU) technique. Despite a lot of research in the past decades, the question which technique is best is still unanswered.

The aim of this study is to compare the proportion of disease recurrences in patients with acquired cholesteatoma, 5 years after Canal Wall Up or Canal Wall Down mastoidectomy.

Methods: We systematically searched Pubmed, CINAHL, Embase and PiCarta from inception up to January 2015 for cohort studies published in English with otoscopicaly confirmed acquired cholesteatoma patients that received either canal wall up, or down mastoidectomy, and in whom disease free status was confirmed with either otoscopy, second look surgery or DWI MRI scan. Risk of bias was critically appraised by 2 different investigators using the Quality in Prognostic Studies (QUIPS) tool. We extracted data on patients and disease status, disease recurrence rates, and diagnostic techniques used for follow-up.

Results: Eight studies on CWD (1092 patients) and CWU (1685 patients) mastoidectomy were included in this review. Risk of bias assessment showed that the decision for CWU or CWD surgical technique was dependent on the extent and location of the pathology in 100% of the studies. The follow up period was insufficient, no distinction was made between residual and recurrent disease, age of the patients was not mentioned or the procedures to detect residuals were not standardized in 50%, 38%, 38% and 100% respectively.

Conclusions: We were unable to compare the disease recurrence rates after the CWU or CWD technique without bias, as the extent and location of the pathology was related to both the choice of surgical approach as well as the outcome. To provide a valid comparison between CWU and CWD, either a randomized clinical trial or standardized prospective registry for cholesteatoma patients is warranted.