Mastoid Obliteration Using S53P4 Bioactive Glass in Cholesteatoma Surgery: A 10-Year Single-Center Experience in 173 Adult Patients with Long-Term Magnetic Resonance Imaging Controlled Follow-up

Abstract

Objective: To present the long-term outcomes of mastoid obliteration in cholesteatoma surgery using S53P4 bioactive glass (BAG) in an adult population. Study Design: Retrospective cohort study. Setting: Single-center study. Patients: All 173 adult patients who underwent primary or revision surgery for cholesteatoma with mastoid obliteration using S53P4 BAG with at least 1 year of follow-up including nonecho planar diffusion-weighted magnetic resonance imaging (MRI) (non-EP DWI MRI) and/or second-look surgery to evaluate recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were included. Intervention(s): Patients underwent CWU or CWD mastoidectomy using S53P4 BAG. Main Outcome and Measures: Cholesteatoma recidivism, postoperative complications, Merchant grade, hearing outcome. Results: Cholesteatoma recidivism was assessed by MRI in 97% of all cases and second-look surgery look surgery in 3% of cases.After a mean follow-up period of 53 months, cholesteatoma recidivism was seen in 10% of the cases (n = 18). Using the Kaplan-Meier curve to extrapolate, a 5-year recidivism rate of 12% was estimated. Only minor complications occurred, all resolving spontaneously or after minor treatment. Merchant grade of 0 to 1 was achieved 95% of the patients, no persistently wet ears were observed. Closure of the air-bone gap within 20 dB was possible in 32%. Conclusion:In this long-term (up to 10 yr) follow-up study, we demonstrated the safety of S53P4 BAG. Minimal and only minor postoperative complications were observed. The effectiveness of BAG was indicated by the low rate of recidivism, even when using non-EP DWI MRI, a sensitive and specific noninvasive technique to detect cholesteatoma recidivism.

Efficacy of S53P4 Bioactive Glass for the Secondary Obliteration of Chronically Discharging Radical Cavities

“…Patients were excluded if the cause of the troublesome radical cavity was middle ear cholesteatoma. The patients reported in our previous publication were not included in this study, as they were diagnosed with cholesteatoma 20 . Cholesteatoma was defined as a mass formed by keratinizing squamous epithelium in the tympanic area, in accordance with the EAONO/JOS Joint Consensus Statement by Yung et al 25 Keratin masses presenting solely in a former radical cavity and that were accessible by cleaning at the outpatient clinic were not considered cholesteatoma by this definition.…”

“…Attention is paid that no cavities exist within the obliteration. Thereafter, the fluid is suctioned from the material and the obliteration is covered with periosteal or fascia flaps 20 . Adequate and sturdy reconstruction of the posterior wall of the EAC is important to prevent displacement of BAG granules during the healing process.…”

“…Thereafter, the fluid is suctioned from the material and the obliteration is covered with periosteal or fascia flaps. 20 Adequate and sturdy reconstruction of the posterior wall of the EAC is important to prevent displacement of BAG granules during the healing process. Follow‐up consisted of clinical otoscopy at 1 and 8 weeks following surgery, at 3‐ to 6‐month intervals for 1 year, and thereafter once yearly unless more frequent visits were deemed necessary.…”

“…Previous studies, including from our own hospital, have demonstrated the use of S53P4 BAG for indications such as cholesteatoma and chronic otitis media 20‐22 . Studies on secondary obliteration of old, purulent, cavities after a previous CWD surgery, without the presence of cholesteatoma, are lacking.…”

“…Previous studies, including from our own hospital, have demonstrated the use of S53P4 BAG for indications such as cholesteatoma and chronic otitis media. 20 , 21 , 22 Studies on secondary obliteration of old, purulent, cavities after a previous CWD surgery, without the presence of cholesteatoma, are lacking. In this study, we present the results of the use of S53P4 BAG for the secondary obliteration of troublesome radical cavities with as main outcome control of infection as graded by postoperative Merchant grade.…”