Premium
Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma
Author(s) -
Hellingman Catharine A.,
Geerse Simon,
de Wolf Maarten J. F.,
Ebbens Fenna A.,
van Spronsen Erik
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27588
Subject(s) - medicine , cholesteatoma , surgery , retrospective cohort study , magnetic resonance imaging , cohort , mastoidectomy , radiology
Objectives/Hypothesis The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum. Study Design Retrospective cohort study in a tertiary referral center. Methods Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI). Results Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed ( P = .066). Conclusions Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates. Level of Evidence 4 Laryngoscope , 129:981–985, 2019