Canal reconstruction mastoidectomy: Outcomes comparison following primary versus secondary surgery.

Compare surgical and audiometric outcomes following canal wall reconstruction (CWR) tympanomastoidectomy used as a primary versus secondary approach for treating cholesteatoma. Retrospective. Patients treated for primary/secondary cholesteatoma from 2006 to 2017 via CWR were included if they had preoperative/postoperative audiograms, detailed operative note(s), and >12 months' follow-up. Patients were stratified by previous surgical history into two groups: primary CWR group (PG) and secondary CWR group (SG). Surgical outcomes measured were prevalence of recidivistic cholesteatoma, canal cholesteatoma, revision rate, and canal wall down (CWD) conversion rates. Secondary outcomes were prevalence of infection, external canal adhesions/stenoses, and retractions. Audiometric outcomes included change in pure-tone average and air-bone gap. We stratified 45 patients/ears into the PG and 26 into the SG. The groups did not significantly differ in age, sex, or smoking status. Overall, median follow-up was 35 months. SG patients had higher rates of cholesteatoma detected at staged surgery than did PG patients (P = .04). However, these patients exhibited lower rates of open revision surgery (4% vs.13%) and a significant improvement in air-bone gap (P = .004). Three PG patients (7%) required conversion to CWD versus zero SG patients. Secondary outcomes were similar. Patients who underwent delayed staging >12 months from CWR had increased rates of recidivism and canal adhesion/stenosis. CWR was effective for treating cholesteatoma as both a primary and secondary surgical approach. SG patients experienced higher rates of recidivism and secondary canal cholesteatoma. PG patients had higher rates of revision surgery. Staging of ears undergoing CWR is important regardless of prior surgical history. 4 Laryngoscope, 129:2580-2587, 2019.

Stevens SM ，Walters ZA ，Babo K ，Peddireddy N ，Tawfik KO ，Samy RN ... -  《-》

Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration.

To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma. Retrospective chart review. Tertiary neurotologic referral center. Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty. Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration. Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates. Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, -2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03). Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon's choice in approach.

Vesole AS ，Doyle EJ 3rd ，Sarkovics K ，Gharib M ，Samy RN ... -  《-》

Long-term results of canal wall reconstruction tympanomastoidectomy.

Walker PC ，Mowry SE ，Hansen MR ，Gantz BJ ... -  《-》

Long-term results of canal wall reconstruction tympanomastoidectomy.

Walker PC ，Mowry SE ，Hansen MR ，Gantz BJ ... -  《-》

Canal wall down approach for tympano-mastoid cholesteatoma: long-term results and prognostic factors.

Pareschi R ，Lepera D ，Nucci R 《-》