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Abraham L, Philip A, Lepcha A, Augustine AM, Mathews SS, Paul RR, Mammen MD. A Comparative Study of Outcomes and Quality of Life in Canal Wall up Mastoidectomies and Canal Wall down Mastoidectomies. Indian J Otolaryngol Head Neck Surg 2022; 74:600-607. [PMID: 36032861 PMCID: PMC9411485 DOI: 10.1007/s12070-021-02424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
Abstract Chronic Otitis Media (COM) of the squamosal type was primarily managed by performing a canal wall down mastoidectomy; however, the latter era otolaryngologist envisioned benefits in preserving the posterior canal wall. Our primary objective was to assess the disease specific quality of life following canal wall up (CWU) mastoidectomy and canal wall down (CWD) mastoidectomy surgery after a 6 month post-operative period. A prospective observational study was done from September 2017 to August 2018 where the charts of 380 patients from Christian Medical College, Vellore were reviewed. Details of patients above 18 years who had undergone the above surgeries for COM active squamosal disease from the period of January 2014 to December 2016; and had their post-operative follow up (average of 16 months) during the period of study were looked at. The CWU group had a significantly better disease-specific quality of life in the symptoms subscale than the CWD group (p value < 0.01). The CWU group showed a significant air-bone gap closure to 23.3 dB as compared to 27.7 dB in CWD (p value = 0.005). The recurrence rates were 4.5% (9 cases) in the CWU group and 3.9% (7 cases) in the CWD group, which was not statistically significant. Both CWU and CWD methods of mastoidectomy for COM squamosal type give comparable outcomes in terms of recurrence with the CWU group having a better disease-specific quality of life after surgery. Level of Evidence 2a.
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Chamoli P, Singh CV, Radia S, Shah AK. Functional and Anatomical Outcome of Inside Out Technique For Cholesteatoma Surgery. Am J Otolaryngol 2018; 39:423-430. [PMID: 29748054 DOI: 10.1016/j.amjoto.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/10/2018] [Accepted: 04/14/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND To study the efficacy of inside-out technique in completely eradicating the cholesteatoma from middle ear and mastoid, preservation of hearing & and quality of life post mastoidectomy with regards to recurrent discharge, wax, granulations. MATERIAL AND METHODS Non-randomized, prospective, observational study performed at the Department of ENT in our hospital. In the study we included 100 patients presenting with chronic suppurative otitis media with cholesteatoma, they underwent inside out mastoidectomy and were followed up till the end of the study to evaluate the efficacy of inside out mastoidectomy in eradicating the disease from the middle ear cleft. To assess preservation of hearing and to assess cavity problems. RESULTS Of the 100 patients, 98 patients had a total clearance of disease by the inside out approach, and 2 patients, had doubtful clearance. All patients came for regular follow up and none of them had residual disease at the end of the study period. Thus, the overall success rate was 100% in our study. A significant improvement in the mean air conduction (p < 0.01) and the mean air bone gap (p < 0.01) was seen in all postoperatively at 3rd month PTA. Only one patient had conductive hearing loss one and a half years postoperatively after initial improvement. A dry self-cleansing cavity was achieved in 95% of the patients and only 5% required regular cleaning of wax the cavities. CONCLUSION Inside out mastoidectomy is a better alternative in canal wall down procedures as it not only clears the disease from the middle ear cleft, but also leaves behind a small postoperative cavity, which will preserve the hearing, decrease the cavity problems and increase the quality of life of such patients.
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James AL. Cholesteatoma in Children: Surgical Technique, Hearing Rehabilitation and Surveillance. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0180-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Uyar Y, Oztürk K, Keles B, Arbağ H, Ulkü CH. Anterior Atticoantrostomy for Cholesteatoma Surgery. Ann Otol Rhinol Laryngol 2016; 115:150-5. [PMID: 16514799 DOI: 10.1177/000348940611500212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. Methods: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. Results: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 ± 13.4 dB and 16.9 ± 14.7 dB, and the mean high-tone bone conduction was 19.0±6.2 dB and 21.1 ±6.6 dB, in the preoperative and postoperative periods, respectively. Conclusions: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.
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Affiliation(s)
- Yavuz Uyar
- Department of Otolaryngology, Meram Faculty of Medicine, Selçuk University, Konya, Turkey
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Kerckhoffs KGP, Kommer MBJ, van Strien THL, Visscher SJA, Bruijnzeel H, Smit AL, Grolman W. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope 2015; 126:980-7. [PMID: 26404516 DOI: 10.1002/lary.25591] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/02/2015] [Accepted: 07/27/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review which type of cholesteatoma surgery, canal wall up (CWU) or canal wall down (CWD), provides the lowest risk for residual and/or recurrent disease in adults with primary acquired cholesteatoma. DATA SOURCES PubMed, Embase, CINAHL, the Cochrane Library, Scopus and Web of Science. STUDY DESIGN We selected articles comparing CWU with CWD, reporting on disease recidivism (combined residual and recurrent disease) or independent residual or disease recurrence rates. We included studies with a moderate to high relevance. RESULTS Our search yielded 2,060 articles. We selected seven studies that carried a moderate risk of bias. Six studies described higher disease recidivism after the CWU procedure [16.7-61.0%] compared to the CWD technique [0-13.2%]. Four studies showed statistical significant difference (P < .05). One study showed opposite results: recidivism was found in 7.8% CWU and in 22.1% CWD cases (P < .001). Studies showed CWU recidivism more likely to be residual disease, whereas CWD recidivism tended to be recurrent disease. CONCLUSION The majority of included studies showed CWU to result in more disease recidivism compared to the CWD technique in adult patients with a primary acquired cholesteatoma. If recidivism risk is the most important factor to consider a certain surgical technique, we recommend application of the CWD procedure. However, many additional factors in patient care will define the best treatment decision, such as residual hearing and access to health care. Our recommendations are based on Level II evidence, which underlines the need for future high-level evidence studies.
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Affiliation(s)
- Kelly G P Kerckhoffs
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
| | - Maarten B J Kommer
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
| | - Thom H L van Strien
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
| | - Simeon J A Visscher
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, Utrecht, The Netherlands
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Tomlin J, Chang D, McCutcheon B, Harris J. Surgical Technique and Recurrence in Cholesteatoma: A Meta-Analysis. ACTA ACUST UNITED AC 2013; 18:135-42. [DOI: 10.1159/000346140] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022]
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Clinical results of atticoantrotomy with attic reconstruction or attic obliteration for patients with an attic cholesteatoma. Clin Exp Otorhinolaryngol 2009; 2:39-43. [PMID: 19434290 PMCID: PMC2671830 DOI: 10.3342/ceo.2009.2.1.39] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 02/03/2009] [Indexed: 11/12/2022] Open
Abstract
Objectives We aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma. Methods Ninety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed. Results There were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2±13.5 dB and 25.0±15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5±9.7 dB and 15.23±14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients. Conclusion Atticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.
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IV. The wet cavity: Individual case decision. Laryngoscope 2009. [DOI: 10.1288/00005537-199512000-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Modified intact canal wall mastoidectomy - long term results in hearing and healing. Indian J Otolaryngol Head Neck Surg 2008; 60:317-23. [PMID: 23120573 DOI: 10.1007/s12070-008-0109-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The classic intact canal wall (ICW) mastoidectomy with tympanoplasty (combined approach tympanoplasty) [1, 2] has anatomic constraints for clearance of disease from the anterior attic and sinus tympani leading to high recidivism. Farrior [3, 4] described the modification of this technique and senior author (AM) has been using it with further modifications since 1973. MATERIALS AND METHODS We report our long-term experience in hearing and healing in 126 cases with special reference to the age (pediatric versus adults), ossicle status (presence or absence of stapes suprastructure) and type of cholesteatoma (Attic versus posterior-superior versus secondary acquired cholesteatoma). RESULTS All the patients had unsafe CSOM and underwent Modified ICW mastoidectomy with primary ossiculoplasty except five where the procedure was staged. CONCLUSION Modified ICW technique is a one-stage procedure with the lowest recidivism rate when compared to various other ICW techniques. There is no significant difference in relation to age of the patient or type of cholesteatoma if the operative cases are selected judicially.
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Bacciu S, Pasanisi E, Perez Raffo G, Avendano Arambula J, Piazza F, Bacciu A, Govoni P, Guida M, Zini C. Scutumplasty: costal cartilage versus bone paté. Auris Nasus Larynx 1998; 25:155-9. [PMID: 9673728 DOI: 10.1016/s0385-8146(98)00005-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study was carried out to evaluate the anatomical and hearing results of the reparation of attic defects in closed tympanoplasty. Reparation was carried out in 194 patients by using a costal cartilage allograft, and in 159 patients with a bone pate autograft. The follow-up was from 1 to 5 years. The study was not truly randomized owing to an occasional lack of allogenic costal cartilage. In the group 'costal cartilage' a partial resorption was observed in 5.7% and a complete resorption in 4.7% of the cases. In the group 'bone pate', partial resorption was observed in 5.5% and total resorption in 2.7% of the patients. Satisfactory hearing results were obtained in 86% of the patients of the group 'costal cartilage' and in 82% of the patients of the group 'bone paté'. Both graft materials may be recommended for repairing erosions caused by the cholesteatoma in the wall of the external auditory canal.
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Affiliation(s)
- S Bacciu
- Department of Otolaryngology, ENT Clinic, University of Parma, Italy
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Karmarkar S, Bhatia S, Saleh E, DeDonato G, Taibah A, Russo A, Sanna M. Cholesteatoma surgery: the individualized technique. Ann Otol Rhinol Laryngol 1995; 104:591-5. [PMID: 7639466 DOI: 10.1177/000348949510400801] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A retrospective analysis of 433 cholesteatoma cases, surgically treated at the Gruppo Otologico, Piacenza, Italy, over a 7-year period, is reported. The purpose of this study was to delineate actual indications for individualizing open and closed procedures and to compare their results as regards residual or recurrent disease and hearing. The total incidences of residual and recurrent cholesteatoma in the open cavity procedures were 10% and 2.38%, respectively, while the closed procedures showed higher incidences of residual and recurrent cholesteatoma: 31.22% and 11.16%, respectively. The problem of a persistently discharging cavity was encountered in only 1 case of an open procedure, while 2 patients had persistent otorrhea among the closed cavity cases. The hearing results, although slightly better in the closed procedures, were not significantly different from those in the open procedures.
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Marco-Algarra J, Gimenez F, Mallea I, Armengot M, de la Fuente L. Cholesteatoma in children: results in open versus closed techniques. J Laryngol Otol 1991; 105:820-4. [PMID: 1753190 DOI: 10.1017/s0022215100117438] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cholesteatoma in children presents characteristics that differentiate it from the adult condition. Surgery has been performed in 55 ears. The main reason for referral was otorrhoea (83 per cent), either alone (29 per cent) or with hearing loss (54 per cent). Apart from three cases with an intact eardrum, a perforation was always present mostly posterior-superior (50 per cent). Open techniques were performed in 27.3 per cent of the ears and the closed technique in 72.7 per cent. Only in 18 per cent of cases was the ossicular chain normal and mobile. The attic was occupied by cholesteatoma in 79 per cent. Recurrence took place in 37 per cent and 13 per cent of the closed and open techniques respectively. Open techniques tend to be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.
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Affiliation(s)
- J Marco-Algarra
- Departamento de Cirugía, Facultad de Medicina, Valencia, Spain
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Edelstein DR, Parisier SC, Ahuja GS, Juarbe C, Chute P, Wenig S, Kaye SM. Cholesteatoma in the pediatric age group. Ann Otol Rhinol Laryngol 1988; 97:23-9. [PMID: 3277523 DOI: 10.1177/000348948809700105] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%.
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Affiliation(s)
- D R Edelstein
- Department of Otolaryngology-Head and Neck Surgery, Manhattan Eye, Ear and Throat Hospital, New York, NY 10021
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Sanna M, Zini C, Gamoletti R, Delogu P, Russo A, Scandellari R, Taibah A. The surgical management of childhood cholesteatoma. J Laryngol Otol 1987; 101:1221-6. [PMID: 3430041 DOI: 10.1017/s002221510010355x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The results of treatment of 124 cases of childhood cholesteatoma are reported in the present study and compared with an adult group of patients. Intact canal wall tympanoplasty was performed in over 90 per cent of cases in children and the procedure was staged in nearly 80 per cent of cases. The children had a 43.8 per cent incidence of residual cholesteatoma and an 8.8 per cent incidence of recurrent cholesteatoma in intact canal wall tympanoplasty cases. Intact canal wall tympanoplasty remains the technique of choice in our hands for the treatment of childhood cholesteatoma; pre-planned staging of the operation is mandatory for the detection and elimination of residual cholesteatoma which occurs more frequently in children.
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Affiliation(s)
- M Sanna
- Clinica Otorinolaringoiatrica 2, Ospedale Maggiore, Parma, Italy
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Sadé J, Berco E, Fuchs C. Results of preservation of the posterior canal wall in cholesteatoma surgery as related to middle-ear aeration. J Laryngol Otol 1986; 100:1351-8. [PMID: 3805876 DOI: 10.1017/s0022215100101136] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The last otological generation witnesses a fierce discussion concerning the treatment of choice of cholesteatomatous ears--closed versus open technique being the issue. The reports of the success and failure of these two opposed techniques varied greatly (McCabe, 1977; Sadé, 1982a). It is the purpose of this study to clarify this issue further by reviewing the fate of 100 cholesteatomatous ears treated by the closed technique and followed up for as long as 13 years--a length of follow-up which has not hitherto been reported. We will also try and attempt to correlate the success and failure of this method with the ability of these ears to aerate--a clinical status which may be regarded as indicating the 'Eustachian function' of any particular middle ear in question.
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Abramson M, Moriyama H, Huang CC. Histology, pathogenesis, and treatment of cholesteatoma. THE ANNALS OF OTOLOGY, RHINOLOGY & LARYNGOLOGY. SUPPLEMENT 1984; 112:125-8. [PMID: 6431871 DOI: 10.1177/00034894840930s421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Factors present in cholesteatoma connective tissue induce bone resorption in chronic otitis media. The presence of skin and its products appears to exacerbate the destructive influence of connective tissue. One exacerbating factor is pressure, shown in an animal model to increase bone resorption by influencing the subepithelial connective tissue. Consideration of pathogenic factors provides a rationale for modifications in the treatment of middle ear cholesteatoma.
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Abstract
Variation in the quality of healing in mastoid cavities has never been clearly understood. It is the author's contention that the factor responsible for the wide variation in healing, even though all chronic disease has been removed, is buried mucosa which leads to cystic formation. Over the past 20 years the author has followed the principle of removing all mucosa from the mastoid segment and has been rewarded with dry ears routinely in open cavity surgery. For the past 12 years he has removed cholesteatoma through tympanoplasty and modified radical mastoidectomy. These cases, also, have been consistently free of cavity problems. In the late 50s and early 60s closed cavity operations were tried in radical mastoidectomy, fenestration and tympanoplasty with mastoidectomy. Postoperative healing difficulties were encountered then that are similar to those being reported now with intact canal wall operation. No conclusions are drawn in the controversy between open and closed cavity techniques. The observation may be made, nevertheless, that the problems of closed cavity operations have not been solved. It is the thesis of this paper that the main objection to open cavity operations, ie, poor quality of healing, has been resolved.
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Abstract
The incidence of cholesteatoma recurrence using intact canal tympanoplasty has been compared in 2 series of operations. The first group represents cases treated with the conventional conservative technique for attic and middle ear surgery. The second group represents cases on which the concept of 'radical attic and middle ear surgery' has been applied and an en bloc homograft has been used for reconstruction. A preliminary survey has shown a much lower incidence of cholesteatoma recurrence in ears belonging to the second group. The advantages of this surgical technique are discussed.
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Bluestone CD, Cantekin EI, Beery QC, Stool SE. Function of the Eustachian tube related to surgical management of acquired aural cholesteatoma in children. Laryngoscope 1978; 88:1155-64. [PMID: 672348 DOI: 10.1002/lary.1978.88.7.1155] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation-deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane-middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear-mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.
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