Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview

Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of themiddle ear andmastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements.

Reconstruction of the Posterior Canal Wall with Mastoid Obliteration after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. SUBJECTS AND METHOD: From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. RESULTS: There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. CONCLUSION: The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall.

Epitympanoplasty with Mastoid Obliteration Technique in Children with Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma in children has a more aggressive growth pattern than observedin adults and often involves the entire mastoid and tympanic cavity, which necessitates early surgical treatment. The rapid tissue growth, the greater degree of infection and inflammation brought on by the Eustachian tube, and well pneumatized mastoid are the major contributing factors for cholesteatoma being so extensive in children. In this study, we evaluated the result of epitympanoplasty and mastoid obliteration in cholesteatoma of children. SUBJECTS AND METHOD: The operation was performed in 28 children patients under the age of 15 from May 11, 1995 to August 13, 2003. They were 3 congenital and 25 acquired cholesteatoma cases, which were accompanied by 4 cases of adhesive otitis media, 1 case of external auditory canal cholesteatoma, and 1 case of congential aural atresia that developed after two operations of canaloplasty. RESULTS: Of the 28 cases, 6 underwent one-staged operation and 8 underwent second-look operations, respectively. In 3 of the 8 cases that underwent second look operation, there was residual cholesteatoma in the tympanic cavity, and cholesteatoma was removed. After operation, there was no recurrent cholesteatoma. Among the 13 cases of ossiculoplasty, 9 could have the test of pure tone audiogram, and 5 cases could preserve postoperative air-bone gap within 30 dB. CONCLUSION: It is expected that epitympanoplasty with the mastoid obliteration technique reduces the air-burden of E-tube in children of cholesteatoma, and the technique probably can prevent the formation of retraction pocket and recurrence of cholesteatoma.

Epitympanoplasty with Mastoid Obliteration Technique in Only/Better Hearing Ears / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is one of serious complications caused after the operation of chronic ear disease. In only/better hearing ears, it is important to minimize the chances of developing a severe hearing loss and to stop the progression of disease. We report the results of performing epitympanoplasty with mastoid obliteration in the only/better hearing ear with cholesteatoma. SUBJECTS AND METHOD: From February 11, 1996 to April 16, 2003, epitympanoplasty and mastoid obliteration was performed for 6 patients with the only hearing ear and 2 with a better hearing ear. In the only/better hearing ears, 7 cases had cholesteatoma and 1 case had adhesive otitis media. The other ears of the 5 cases had previously received canal wall down mastoidectomy, 2 cases sensorineural hearing loss and 1 case both epitympanoplasty and mastoid obliteration. The observation period ranged from 7 to 99 months, with the average of 45 months. RESULTS: One-staged operation was performed on all 8 patients. Four cases got total ossicular replacement prosthesis, 3 cases received partial ossicular replacement prosthesis, and 1 case received autologous cartilage short columellization. After each operation, all patients obtained a dry, safe, self-cleansing ear and recurrence did not occur. The hearing results in this series showed that the air conduction thresholds, bone conduction thresholds and air-bone gaps were preserved in 7 cases, but became worse in one patient. Two patients did not need to use hearing aids, five patients used an hearing aid of in-the-canal (ITC) type, one patient used a hearing aid of completely-in the canal (CIC) type. CONCLUSION: Epitympanoplasty with mastoid obliteration in the only/better hearing not only can stop the progression of cholesteatoma, but also can preserve hearing of patients.

The Effect of Mastoid Obliteration Technique Using Superiorly Based Musculoperiosteal Flap and Autologous Conchal Cartilage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The debate regarding the surgical technique for the management of open mastoid cavity still continues. In this study, we investigated the mastoid obliteration effect of superiorly based musculoperiosteal flap (SBF) with or without the combination of autologous conchal cartilage comparing with the well known Palva flap. MATERIAL AND METHOD: The 51 ears of 51 chronic otitis media or cholesteatoma patients who had been performed open cavity tympanomastoidectomy surgery with mastoid obliteration during the period from 1998 to 1999 were included in this study. Of the 51 ears, mastoid obliteration was performed using SBF and conchal cartilage in 25 ears, using SBF only in 18 ears and using the Palva flap in 8 ears. The duration of cavity epithelization and the increment of ear canal volume were compared among these three groups. The volume of ear canals and postoperative cavities were measured by filling the ear canals with sterile saline solution up to the cartilaginous part of the ear canal, starting at the level of tympanic membrane when the patient was lying on his side with the ear examined facing upward. RESULTS: Analysis of the data showed significant differences among the three groups in either duration of cavity epithelization (SBF & cartilage: 76+/-20 days, SBF only : 85+/-18 days and Palva flap : 106+/-21 days) and increased rate of postoperative ear canal volume (SBF & cartilage : 72%, SBF : 102% and Palva flap : 171%). CONCLUSION: The results of this study shows better outcomes in the groups of SBF & cartilge or SBF only compared with the group of Palva flap in terms of duration of cavity epithelization and increment of ear canal volume. Especially, SBF combined with autologous conchal cartilage achieves more favorable results. Thus, we suggest that the SBF & cartilage mastoid obliteration technique is one of the useful technique for the patients with open cavity tympanomastoidectomy.

Results of Epitympanoplasty with Mastoid Obliteration Technique / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of chronic otitis media including cholesteatoma. The CWD method can secure a good operation field and remove the lesion easily, but it accompanies a cavity problem. The CWU method also has its shortcomings as it is difficult to eliminate cholesteatoma completely using this method. Combining the advantages of both methods, we invented a new operational method. The present study assesses the results of its use after a follow up of 55 months. MATERIALS AND METHODS: From December of 1994 to March of 1997, epitympanoplasty with mastoid obliteration was conducted on 44 adults (42 patients). Of these, 38 cases were cholesteatomas, 2 cases adhesive otitis media and 4 cases chronic otitis media with poor E-tube function. The postoperative observation period ranged from 41 to 68 months, with the average period of 55.2 months. RESULTS: There were 3 cases of residual cholesteatoma in the mastoid cavity and 3 cases in the middle ear cavity. All residual cholesteatomas in the mastoid cavity were treated with CWU, and there was no recurrent cholesteatoma or otorrhea, nor retraction pocket. CONCLUSION: Although the observation period of the postoperative process was not long enough, there was no recurrence. We suggest that it is advantageous to operate on cholesteatoma using the new method.

Partial Mastoid Obliteration Using Inferior Based Musculoperiosteal Flap and Autogenous Conchal Cartilage Chips / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, canal down mastoidectomy tends to be more frequently selected for complete eradication of the lesion and prevention of recurrence. Therefore, the problems attendant to the open mastoid continue to be of concern. Although various techniques have been used to solve the cavity problems, no single procedure has yet been devised that entirely accomplished this purpose. We evaluated the effects of partial mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips. MATERIALS AND METHODS: Twenty four cases were performed with mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips obtained from meatoplasty. There were 11 cases for control which were performed with canal down mastoidectomy without obliteration. We compared these two groups in the duration of epithelialization, accumulation of debris, presence or absence of drainage, shape of remodeled canal and caloric response and evaluated survival or atrophy of flap and absorption of cartilage chips. RESULTS: Obliteration group showed more rapid healing and epithelialization and less accumulated epithelial debris. Atrophy of flap or absorption of cartilage was not observed. There was no draining ear but vertigo with nystagmus on caloric stimulation developed in both groups. CONCLUSION: This partial mastoid obliteration technique used easy and quick application instead of complete restoration of canal wall, and it may be also valuable in providing rapid epithelialization and reducing mastoid bowl volume with relatively round canal shape. Furthermore, epitympanic obliteration using cartilage chips may be an effective method to prevent formation of attic retraction pocket.

The Effect on Acoustic Characteristics of Surgical Modification of the External Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The peak resonance corresponds to the fundamental frequency whose wavelength is approxi-mately four times the canal length and is between 2 and 3 kHz in a normal ear canal. The possibility that creation of an open cavity mastoid alters the acoustical characteristics of the external ear has been suggested. The aim of this study was to ascertain the acoustical changes in the external auditory canal occasioned by the open cavity mastoidectomy, and compare it with the mastoid obliteration. MATERIALS AND METHODS: We measured the external ear resonance (EER) characteristics in 40 normal ears, 20 ears with open cavity mastoid and 40 ears with obliterated mastoids. The EER characteristics were measured using 6500 hearing aid test system. RESULTS: The means of the peak resonant frequency and the peak amplitude at open cavity mastoids (2350 Hz, 18.5 dB) showed significant differences (p<0.1) when compared with those at normal mastoids. However, the means at obliterated mastoids (2850 Hz, 20.5 dB) recovered to the near normal state. CONCLUSION: While the open cavity mastoidectomy can affect the resonance frequency, the mastoid obliteration may help anatomical reconstruction as well as acoustical recovery.