The Bony Obliteration Tympanoplasty in Pediatric Cholesteatoma: Long-term Hearing Results

Abstract

The CWU bony obliteration tympanoplasty in a consecutive series of pediatric extensive cholesteatoma shows a similar to slightly improved hearing outcome as compared with CWU surgery without BOT. Although the series shows a clearly reduced reoperation rate and a significantly improved safety and hygienic outcome as compared with CWU without BOT, better hearing outcomes remain desirable in this group of children.

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

“…They demonstrated a residual rate of 5.8% and a recurrence rate of 2.9% in a pediatric population. 5 Our results are comparable with this study. Moreover, we feel that due to the inclusion of the learning curve and inclusion of five different surgeons with varying experience, our results are a better representation of general practice.…”

“…14 A lower residual rate can be explained by the meticulous elimination of all soft tissues from the cavity to prepare the ear for obliteration. 5 Furthermore, as the mastoid is obliterated afterward, the surgeon may be less constrained to remove part of the scutum for a direct visualization of the cholesteatoma. Another argument may be that residual skin is not able to develop into cholesteatoma in a bony obliterated space, which is called the Hinohira effect.…”

“…15 Regardless of the causative mechanism, obliteration seems to improve the outcome of cholesteatoma surgery in a variety of studies using different materials for obliteration, ranging from autologous material (e.g., cartilage, bone, musculoperiosteal flaps) to biocompatible alloplastic materials (e.g., hydroxyapatite, bioactive glass). 3,5,[7][8][9][10][11][12]16 A huge concern with obliteration has always been the possibility of a silent cholesteatoma within the obliterated cavity. The recent development of MRI-DWI ensures a reliable way to detect such cholesteatoma within the obliterated cavity, mitigating concerns that residual cholesteatoma could be missed.…”

“…2 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. 5 In our tertiary referral hospital we use cartilage chips or a midtemporal artery flap in combination with bone pâté and/or hydroxyapatite granules for obliteration following CWU surgery for cholesteatoma. The objective of this study was to evaluate surgical outcome and residual and recurrence rates of CWU surgery for cholesteatoma combined with obliteration of the epitympanum and mastoid using this technique.…”

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

“…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. [1][2][3] 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 4,5 and to facilitate middle ear aeration 6 after a closed technique with insufficient postoperative middle ear aeration. In both canal-wall-down and canalwall-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.…”