Learning Objectives: Handling of Canal wall up and Canal wall down mastoidal cavities in cholesteatoma surgery.

Danish Otology Society symposium

Mastoidectomy is often necessary in cholesteatoma surgery. If the posterior ear canal wall can be preserved, the mastoidal cavity remains in contact with the middle ear air space, even though it is often filled with scar tissue. The pressure-regulating role of the mastoid mucosa is presumably destroyed or severely diminished due to removal of the trabecular structure. Should the canal wall-up cavity be obliterated in order to prevent recurrence of a cholesteatoma? Or should it be left open allowing subsequent re-aeration? The latter includes a risk of renewed negative pressure in the middle ear and mastoid and the development of recurrent cholesteatoma.

If the posterior ear canal wall has to be removed producing a modified radical cavity, the ear canal is substantially enlarged. This implies regular cleaning (often by an ENT specialist), and moist and infections in the cavity can be troublesome. Should the cavity be obliterated in order to restore the ear canal to its normal size? Or should it be left open for optimal disease control? We have developed a strategy with partial obliteration and enlargement of the ear canal opening. Bone dust, cartilage, fascia and on rare occasions artificial material can be used for obliteration. We find that a partial obliteration diminishes the need for postoperative ear care.