Epitympanoplasty with Cartilage Obliteration in the Canal Wall Up Technique to the Middle Ear Cholesteatoma / 听力学及言语疾病杂志

Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .

Epitympanoplasty with Mastoid Obliteration Technique: 38 Months Follow-Up Results of 283 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy and canal wall up mastoidectomy, which are operational methods used to eliminate the lesion of chronic otitis media including cholesteatoma. Combining the advantages of both methods, we devised a new operational method in 1994. This study reports the surgical results of the epitympanoplasty employing the mastoid obliteration technique after a follow-up 38 months in 283 cases. SUBJECTS AND METHOD: A retrospective review was made of 283 cases (273 patients) on which this technique was performed by the first author between Dec. of 1994 to Mar. of 2004. The follow-up period varied from 8 to 104 months, with the average period of 38 months. We analyzed postoperative complications including cavity problems, the recurrent cholesteatoma, residual cholesteatoma cases in the mastoid cavity, residual cholesteatoma in the tympanic cavity and postoperative otorrhea and hearing results. RESULTS: The overall incidence of postoperative complications was 21.9%. The results of postoperative complications in the above listed order were 0%, 0%, 1.0%, 4.3% and 5.7%, respectively. Air-bone gap (ABG) closure was 4.73 dB HL and the statistical analysis revealed that the postoperative ABG was significantly lower than the preoperative ABG (p=0.0023). CONCLUSION: The present study suggests that this procedure prevents the cavity problem, helps reduce recurrence and effectively manages the residual cholesteatoma. Also, this procedure achieves good audiologic results.

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.

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.

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.