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Long-term Results of Troublesome CWD Cavity Reconstruction by Mastoid and Epitympanic Bony Obliteration (CWR-BOT) in Adults

Presenting Author: Jean-Philippe Vercruysse

Published online by Cambridge University Press:  03 June 2016

Jean-Philippe Vercruysse ,
Joost van Dinther ,
Bert De Foer ,
Jan Casselman ,
Thomas Somers ,
Andrzej Zarowski ,
Cor Cremers  and
Erwin Offeciers
Jean-Philippe Vercruysse
Affiliation:
European Institute of ORL
Joost van Dinther
Affiliation:
European institute of ORL, Antwerp
Bert De Foer
Affiliation:
Department of radiology, Sint-Augustine Hospital, Antwerp
Jan Casselman
Affiliation:
Department of radiology, Sint-Augustine Hospital, Antwerp
Thomas Somers
Affiliation:
European institute of ORL, Antwerp
Andrzej Zarowski
Affiliation:
European institute of ORL, Antwerp
Cor Cremers
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen
Erwin Offeciers
Affiliation:
European institute of ORL, Antwerp
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Abstract

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Learning Objectives: To present the long-term surgical outcome of the bony mastoid and epitympanic obliteration technique with canal wall reconstruction (CWR-BOT) in adults with an unstable cavity after prior canal wall-down surgery (CWD) for extensive cholesteatoma Study Design: Retrospective study Interventions: Therapeutic Setting: Tertiary referral center Patients: Fifty consecutive adult patients undergoing a CWR-BOT between 1998 and 2009. Main Outcome Measure(s): (A) Recurrence and residual rates of cholesteatoma, (B) postoperative hygienic status of the ear, including postoperative aspect of the tympanic membrane (TM) and external ear canal integrity (EAC), (C) functional outcome and (D) long-term safety issues. Results: (A) The percentage of ears remaining safe without recurrent or residual disease after CWR-BOT was 96% after a mean follow-up time of 101,8 months. Recurrent cholesteatoma occurred in 2% (n = 1) and a residual cholesteatoma was detected in 2% (n = 1) of the cases. (B) A safe dry, and trouble-free graft and self- cleaning EAC was achieved in 94%. (C) The postoperative hearing results showed a gain of 1,7 dB on pure-tone average air-conduction (PTA-AC). (D) Non-echo planar diffusion weighted imaging (non-EP DW MRI) documented the residual (n = 1) and recurrent cholesteatoma (n = 1). The 1 and 5 year Imaging follow-up revealed no other recurrent or residual disease. Conclusions: The CWR-BOT is a safe and very effective option for treatment of problematic unstable canal wall-down mastoid cavities, resulting in dry trouble-free ears.

Objective: To present the long-term surgical outcome of the bony mastoid and epitympanic obliteration technique with canal wall reconstruction (CWR-BOT) in adults with an unstable cavity after previous canal wall-down surgery for extensive cholesteatoma.

Study Design: Retrospective study.

Interventions: Therapeutic.

Setting: Tertiary referral center.

Patients: Fifty consecutive adult patients undergoing a CWR-BOT between 1998 and 2009.

Main Outcome Measure(s): (A) Recurrence and residual rates of cholesteatoma, (B) postoperative hygienic status of the ear, including postoperative aspect of the tympanic membrane and external ear canal integrity (EAC), (C) functional outcome, and (D) long-term safety issues.

Results: (A) The percentage of ears remaining safe without recurrent or residual disease after CWR-BOT was 96% after a mean follow-up time of 101.8 months. Recurrent cholesteatoma occurred in 2% (n = 1) and a residual cholesteatoma was detected in 2% (n = 1) of the patients. (B) A safe dry, and trouble-free graft and selfcleaning EAC was achieved in 94%. (C) The postoperative hearing results showed a gain of 1.7 dB on pure-tone average air-conduction. (D) Nonecho planar diffusion-weighted imaging (non-EP DW magnetic resonance imaging) documented the residual (n 1⁄4 1) and recurrent cholesteatoma (n = 1). The 1 and 5-year imaging follow-up revealed no other recurrent or residual disease. Conclusion: The CWR-BOT is a safe and very effective option for treatment of problematic unstable canal wall- down mastoid cavities, resulting in dry trouble-free ears.