Intact canal wall tympanoplasty in the management of cholesteatoma

Abstract

There are presently two schools of thought on the proper surgical management of cholesteatoma associated with chronic ear disease: one feels that the ear should be exteriorized and left "open"; the other takes the position that the disease can be removed, and the ear left in its normal anatomical and functional state. The latter group are known to favor a "closed" or more conservative procedure. The purpose of this paper is to review a series of patients who have had cholesteatoma managed by an intact canal wall procedure that prevents a postoperative cavity. Out of a series of 590 chronic ear surgeries performed between January 1, 1970, and December 31, 1974, there were 179 done for cholesteatoma (30 percent). There were 153 patients, 26 of whom had bilateral disease. Twenty-three patients were lost to follow-up, giving an overall total of 154 surgeries with from one to five-year information. The overall follow-up rate was 85 percent. Recurrent cholesteatoma was the most bothersome complication and occurred in 14 percent of the series. Residual cholesteatoma was managed by doing all procedures in two stages. The authors feel that the intact canal wall tympanoplasty is a procedure that will gain acceptance and will be more widely used in the future.

Intact Canal Wall Tympanomastoid Surgery: 10 Years Experience

“…In our series, the frequency of residual and recurrent disease in 16 cases (5.8%) and thus considerably lower than the frequency observed in the classic CAT [12][13][14][15][16][17]. Removal of the disease from tympanic sinus is safer and easier via transcanal route after otosclerosis drilling of posterosuperior bony annulus.…”

“…Removal of disease from the anterior attic through the cortical mastoidectomy and from the tympanic sinus through the posterior tympanotomy is complicated, especially under narrow anatomical conditions and the large frequency of residual cholesteatoma is therefore not surprising [10][11][12][13][14][15][16][17][18].…”

Outcome of intact canal wall mastoidectomy in limited attic cholesteatoma

“…Glasscock et al have mentioned that the intact canal wall tympanoplasty is a procedure that will gain acceptance and will be more widely used in the future. 7 It was a routine practice to do a second look procedure in all cases of ICW surgery. Reimer et al have quoted a high rate of recidivism and a second stage surgery in most cases of ICW Mastoidectomy.…”

Endoscopic transcanal middle ear surgery

“…Only in advanced cases does a cholesteatoma progress further to reach the mastoid cavity proper. Most surgical failures associated with a postauricular approach seem to occur rather than in the mastoid [28][29]. Therefore, the most transcanal access to the tympanic membrane and tympanic cavity and the subsequent step-by-step pursuit of the sac as it passes through the middle ear.…”