Total Mastoid Obliteration in Staged Canal-Up Tympanoplasty for Cholesteatoma Facilitates Tympanic Aeration

Objective: To assess middle ear aeration after total mastoid obliteration using bone pate and hydroxyapatite performed at the second stage of intact-canal-wall (ICW) tympanoplasty. Study Design: Retrospective study. Setting: Tertiary referral hospital. Patients: Forty-two ears with cholesteatoma underwent the obliteration. Computed tomography (CT) scan 1 week before the second-stage operation showed disturbance of middle ear aeration. In the 27 ears of these cases, temporal bone CT scans taken 3 years or more after the operation were available. Intervention: We performed second-stage ICW tympanoplasty 1 year after the first-stage canal-up operation. After mastoidectomy and ossiculoplasty, communication between the tympanic cavity and antrum was blocked with cartilage flaps, and the antrum and mastoid cavity were obliterated totally with bone pate alone or combined with hydroxyapatite granules. Main Outcome Measures: Otomicroscopic and otoendoscopic assessment for ear drum retraction was graded. Tympanic aeration assessed with CT when available. Results: After the total mastoid obliteration in the second-stage ICW tympanoplasty, no postoperative complications nor residual cholesteatoma were encountered. The incidence of ear drum retraction was significantly correlated with the grade of tympanic aeration. Conclusion: The total mastoid obliteration done at the second-stage ICW tympanoplasty is a safe procedure that facilitates aeration of the tympanic cavity. In ears with restored tympanic aeration, the probability of a retraction pocket development is low. On the contrary, possibility of retraction pocket development is high in the ears with poor tympanic aeration after the second-stage operation.

[1]  J. Casselman,et al.  Mastoid and Epitympanic Bony Obliteration in Pediatric Cholesteatoma , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[2]  K. Gyo,et al.  Improvements to staged canal wall up tympanoplasty for middle ear cholesteatoma , 2007, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[3]  S. H. Kim,et al.  Mastoid and Epitympanic Obliteration in Canal Wall Up Mastoidectomy for Prevention of Retraction Pocket , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[4]  M. Hansen,et al.  Canal Wall Reconstruction Tympanomastoidectomy with Mastoid Obliteration , 2005, The Laryngoscope.

[5]  J. Dornhoffer,et al.  The Use of Demineralized Bone Matrix for Mastoid Cavity Obliteration , 2004, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[6]  J. Roberson,et al.  Mastoid Obliteration: Autogenous Cranial Bone pÂte Reconstruction , 2003, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[7]  R. Minoda,et al.  Efficacy of Mastoid Cortex Plasty for Middle Ear Aeration in Intact Canal Wall Tympanoplasty for Cholesteatoma , 2002, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[8]  N. Yanagihara,et al.  Mastoid Cortex Plasty Using Bone Pate , 2002, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[9]  O. Hilmi,et al.  Reconstruction of Mastoid Cavity With Hydroxyapatite Cement and Postauricular Flap , 2002, The Laryngoscope.

[10]  S. Estrem,et al.  Hydroxyapatite Canal Wall Reconstruction/Mastoid Obliteration , 1999, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[11]  Grote Jj.  Results of cavity reconstruction with hydroxyapatite implants after 15 years. , 1998 .

[12]  J. J. Grote.  Results of cavity reconstruction with hydroxyapatite implants after 15 years. , 1998, The American journal of otology.

[13]  K. Gyo,et al.  Prevention of recurrence of cholesteatoma in intact canal wall tympanoplasty. , 1993, The American journal of otology.

[14]  U. Mercke.  The cholesteatomatous ear one year after surgery with obliteration technique. , 1987, The American journal of otology.

[15]  E. Vartiainen,et al.  Mastoid obliteration in intact canal wall mastoidectomy. , 1987, Clinical otolaryngology and allied sciences.