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How to achieve a dry care free mastoidectomy cavity

Presenting Author: Udi Katzenell

Published online by Cambridge University Press:  03 June 2016

Udi Katzenell ,
Rona Bourla  and
Doron Halperin
Udi Katzenell
Affiliation:
Kaplan Medical Center
Rona Bourla
Affiliation:
Kaplan Medical Centre, The Department of Otolaryngology Head and Neck Surgery, Affiliated to the Faculty of Medicine of the Hebrew University of Jerusalem
Doron Halperin
Affiliation:
Kaplan Medical Centre, The Department of Otolaryngology Head and Neck Surgery, Affiliated to the Faculty of Medicine of the Hebrew University of Jerusalem
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Abstract

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Learning Objectives:

Objectives: This study investigates the clinical results of canal wall down mastoidectomy (CWDM).

Methods: The clinical records of patients who had primary or revision canal wall down mastoidectomy between 9/2011 and 12/2015 in Kaplan Medical Center were reviewed. All surgeries were performed in a uniform technique by two experienced surgeons.

Results: 39 patients had CWDM with the average age of 34 years (5–87). 72% (28) were male and 11 (28%) were female. For 51% (20) it was a revision surgery. 46% (18) had a contralateral pathology and 7(18%) had contralateral surgery. 7% (2) had recurrence of the cholesteatoma after surgery. The Nadol cavity grading after surgery was grade 0 (No discharge events and no granulations) in 71% (22) of the patients, grade 1 (one event of discharge which is shorter than two weeks in the past three months or no discharge with a sensation of a wet ear) in 13% (4) and grade 2 (persistant discharge or granulations in examination or a need for revision surgery) in 16% (5) patients. We did not have enough information to determine the Nadol grading for 5 patients. 35% (14) did not practice water precautions of whom only one experienced a vestibular effect. 10% (4) used a hearing aid, one had a Bone Anchored Hearing Aid and one had a Bonebridge.

Conclusions: CWDM is reserved for aggressive or recurrent cholesteatoma. We believe that the following are essential for the achievement of a dry care free cavity with a low recurrence rate and rare vestibular effect: evacuate all mastoid air cells, avoid overhangs of the tegmen, drill the sinudural angle, amputate the tip, lower the facial ridge, drill down the inferior part of the tympanic bone, smoothen obliterate the mastoid cavity with bone pate, perform an adequate miatoplasty and use an antiseptic dressing like BIPP. Most patients continue to practice water precautions although the cavity is dry and do not accept hearing rehabilitation with a hearing aid or a bone anchored hearing device.