The Bony Obliteration Tympanoplasty in Pediatric Cholesteatoma

Dinther, Joost J. S. van; Vercruysse, Jean‐Philippe; Camp, Sophie; Foer, Bert De; Somers, Thomas; Zarowski, Andrzej; Cremers, C.W.R.J.; Offeciers, Erwin

doi:10.1097/mao.0000000000000851

Cited by 28 publications

(23 citation statements)

References 22 publications

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“…In this study, bone chips and bone dust are used to obliterate the mastoid and epitympanum. They demonstrated a residual rate of 5.8% and a recurrence rate of 2.9% in a pediatric population . Our results are comparable with this study.…”

Section: Discussionsupporting

confidence: 90%

“…Reconstruction of the posterior canal wall after CWD surgery with or without obliteration of the mastoid seems to combine a low residual and recurrence rate comparable with CWD surgery with a low ear discharge rate . Bony obliteration tympanoplasty (CWU surgery combined with bony obliteration of the epitympanum and mastoid) is demonstrated to significantly lower the residual and recurrence rates of cholesteatoma while keeping the original posterior canal wall intact as well …”

Section: Introductionmentioning

confidence: 99%

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Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

et al. 2018

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Objectives/Hypothesis The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum. Study Design Retrospective cohort study in a tertiary referral center. Methods Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI). Results Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P = .066). Conclusions Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates. Level of Evidence 4 Laryngoscope, 129:981–985, 2019

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

et al. 2018

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“…Mastoid obliteration is used to reduce the recurrence and the residual rate in primary cholesteatoma surgery using both canal‐wall‐up and canal‐wall‐down procedures . Moreover, obliteration of an unstable mastoid cavity leads to significantly better results for discharge, hearing rehabilitation and imbalance than a revision canal‐wall‐down procedure …”

Section: Discussionmentioning

confidence: 99%

“…Otorrhoea, difficulty in fitting a hearing aid when needed and vertigo or imbalance due to thermal stimulation of the posterior labyrinth are often undesirable outcomes of a canal‐wall‐down mastoidectomy . Obliteration has also been performed in canal‐wall‐up mastoidectomy, although less frequently, to reduce the recurrence and residual rate of cholesteatoma in adults and children and to facilitate middle ear aeration after a closed technique with insufficient postoperative middle ear aeration. In both canal‐wall‐down and canal‐wall‐up mastoidectomies, obliteration of the paratympanic spaces reduces the mucosal surface thus slowing gas absorption and pressure changes responsible for recurrence and improving long‐term surgical outcome…”

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confidence: 99%

Anatomical, functional and quality‐of‐life results for mastoid and epitympanic obliteration with bioactive glass s53p4: a prospective clinical study

Bernardeschi

Pyatigorskaya

Russo

et al. 2016

Clinical Otolaryngology

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“…This is becoming increasingly important to answer with the recent popularization of mastoid obliteration surgeries for cholesteatoma [11–14], first introduced by Mercke [15]. In these techniques, the mastoid is completely obliterated with bone pate, to prevent recurrence of cholesteatoma in this region.…”

Section: Introductionmentioning

confidence: 99%

Middle ear ventilation status postoperatively after translabyrinthine resection of vestibular schwannoma with mastoid obliteration and Eustachian tube occlusion: is the Eustachian tube enough to ventilate the middle ear without the mastoid air cell system?

Belyea

Wickens

Bance

2016

J of Otolaryngol - Head & Neck Surg

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BackgroundGas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma.MethodsA retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op.ResultsTwenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain middle ear pressure in the absence of a mastoid cavity. Because some had negative pressures post TL resection, the average change in pre and postoperative pressure was -37.5 daPa for the operative side and 7.8 daPa for the non-operative side. This was significantly different.DiscussionThe difference for change in pre and postoperative pressure and compliance between operative and non-operative side might be expected from the ET plugging during TL resection. However, more interesting are those patients in whom the ET presumably reopens, and in these subjects, despite having no mastoid compartment at all, and the space obliterated with fat, they were still able to maintain normal ventilation of the middle ear space.ConclusionOur findings imply that the ET alone is adequate to ventilate at least the reduced middle ear space following TL surgery in most subjects, and perhaps in 100 % if the ET hadn’t been plugged during surgery. Hence, the mastoid air cell system, even when healthy, is not needed to maintain air in the middle year cleft.

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The Bony Obliteration Tympanoplasty in Pediatric Cholesteatoma

Abstract: The use of a canal wall up approach with obliteration of the mastoid cavity and epitympanic space to surgically treat cholesteatoma in children results in low residual and recurrence rates and a high rate of trouble-free ears in the long term.

Cited by 28 publications

References 22 publications

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Anatomical, functional and quality‐of‐life results for mastoid and epitympanic obliteration with bioactive glass s53p4: a prospective clinical study

Middle ear ventilation status postoperatively after translabyrinthine resection of vestibular schwannoma with mastoid obliteration and Eustachian tube occlusion: is the Eustachian tube enough to ventilate the middle ear without the mastoid air cell system?

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