Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy.

Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using bioactive glass (BAG) that is fabricated and built up intraoperatively. This study was applied on 20 patients had atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. During a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006). Surgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.

Sorour SS ，Mohamed NN ，Abdel Fattah MM ，Elbary MEA ，El-Anwar MW ... -  《-》

Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy.

Elbary MEA ，Nasr WF ，Sorour SS 《-》

Mastoid obliteration with S53P4 bioactive glass after canal wall down mastoidectomy: Preliminary results.

Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).

Król B ，Cywka KB ，Skarżyńska MB ，Skarżyński PH ... -  《-》

A technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy.

To present a simple technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy, and to assess the efficacy and the surgical results of this technique. Retrospective clinical study of a consecutive series of procedures from 2004 to 2008. One hundred thirteen patients undergone canal wall down mastoidectomy with tympanoplasty and concurrent procedure of mastoid obliteration and meatoplasty that uses an anteriorly based musculoperiosteal flap and a horizontal skin incision on the concha were included. Preoperative diagnoses were classified into cholesteatoma, adhesive otitis media, and chronic suppurative otitis media. The mean duration of follow-up was 38 months, with a range of 12-75 months. We analyzed control of suppuration and creation of a dry mastoid cavity according to the Merchant's grading system for evaluation of the efficacy of this technique, and hearing outcome. We evaluated postoperative complications including development of recurrent or residual cholesteatomas and duration of the mastoid cavity achieving a complete healing. Seventy-two patients had cholesteatoma, whereas 27 patients had adhesive otitis media and 14 patients had chronic suppurative otitis media. Eighty-three percent of all patients, in 86% of patients with cholesteatoma, in 78% of patients with adhesive otitis media, and in 78% of patients with chronic suppurative otitis media were achieved a dry and self-cleaning mastoid and complete control of infection. Duration of the mastoid cavity achieving a dry and self-cleaning mastoid ranged from 4 weeks to 24 weeks and the mean time of the complete epithelialization was 11.1±4.6 weeks. The average ABGs were 32.4±13.8dB preoperatively and 23±13.2dB postoperatively. There were 5 patients with failure of control of infection postoperatively and 3 patients of recidivistic cholesteatoma. The efficacy of our technique to make a dry and healthy mastoid cavity after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method to prevent cavity problems after canal wall down mastoidectomy.

Kim CW ，Oh JI ，Choi KY ，Park SM ，Park MI ... -  《-》

Alternative to canal wall-down mastoidectomy for sclerotic mastoid cavities: epitympanoplasty with mastoid obliteration.

Heo KW ，Kang MK ，Park JY 《-》