Surgical Therapy of Chronic Mastoiditis with Cholesteatoma

Abstract

One hundred fifty-seven ears treated surgically for chronic mastoiditis with cholesteatoma are reviewed. The selection of an operative procedure ("canal wall up" or "canal wall down") was dictated by the extent of pathologic indications in relation to the size of the patient's mastoid. The incidence of recurrent or residual cholesteatoma, the hearing results, and the frequency of visits required for mastoid cavity care are reported.

Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

“…In cholesteatoma surgery, the two major and traditional surgical approaches which are commonly used are more or less antagonistic in their concept. The functional approach is called Canal Wall Up (CWU), which keeps the posterior wall of the outer ear canal intact during surgery 1 . By using this technique, the surgeon is allowed to create a functional middle ear in the original dimensions of the tympanic cavity at the end of the surgery, and the shape of the outer ear canal and its entrance will not be changed.…”

“…The functional approach is called Canal Wall Up (CWU), which keeps the posterior wall of the outer ear canal intact during surgery. 1 By using this technique, the surgeon is allowed to create a functional middle ear in the original dimensions of the tympanic cavity at the end of the surgery, and the shape of the outer ear canal and its entrance will not be changed. However, the intact posterior wall hampers the intraoperative control of the cholesteatoma, a potential residual disease can be hidden in the mastoid cavity during follow-up, and recurrences can grow into this space again.…”

Tinnitus in Patients with Chronic Mastoiditis and Cholesteatoma

“…Some examples are as follows: the acoustic trauma caused by the shrill noise of the suction irrigation and the high speed drill; excessive movement of the stapes when removing disease or reconstructing the ossicular mechanism; inadvertent transmission of the drill vibrations through the ossicular chain into the inner ear; accidental displacement of the stapes and perilymphatic fluid leaks. The depression of bone conduction at 4000 Hz that has been observed following middle ear mastoid operations reflects this slight detrimental effect on inner ear function (Parisier et al, 1982). However, it must be stressed that most patients who experienced similar small changes in hearing acuity did not develop tinnitus.…”

“…One hundred and fifty-three patients with chronic mastoiditis due to cholesteatoma underwent surgery to treat their condition (Parisier, et al, 1982). A retrospective study of tinnitus in this group of individuals was done by written questionnaire.…”