Clin Exp Otorhinolaryngol.  2019 Nov;12(4):360-366. 10.21053/ceo.2018.01333.

Outcomes of Modified Canal Wall Down Mastoidectomy and Mastoid Obliteration Using Autologous Materials

• Kim BG
• Kim HJ
• Lee SJ
• Lee E
• Lee SA
• Lee JD

• KMID: 2462731
• DOI: http://doi.org/10.21053/ceo.2018.01333

Abstract

OBJECTIVES
The traditional canal wall down mastoidectomy (CWDM) procedure commonly has potential problems of altering the anatomy and physiology of the middle ear and mastoid. This study evaluated outcomes in patients who underwent modified canal wall down mastoidectomy (mCWDM) and mastoid obliteration using autologous materials.
METHODS
Our study included 76 patients with chronic otitis media, cholesteatoma, and adhesive otitis who underwent mCWDM and mastoid obliteration using autologous materials between 2010 and 2015. Postoperative hearing air-bone gap and complications were evaluated.
RESULTS
During the average follow-up of 64 months (range, 20 to 89 months), there was no recurrent or residual cholesteatoma or chronic otitis media. No patient had a cavity problem and anatomic integrity of the posterior canal wall was obtained. There was a significant improvement in hearing with respect to the postoperative air-bone gap (P<0.05). A retroauricular skin depression was a common complication of this technique.
CONCLUSION
The present study suggests that our technique can prevent various complications of the classical CWDM technique using autologous tissues for mastoid cavity obliteration. It is also an appropriate method to obtain adequate volume for safe obliteration.

Keyword

Mastoidectomy; Mastoid; Cartilage; Bone

MeSH Terms

Adhesives
Cartilage
Cholesteatoma
Depression
Ear, Middle
Follow-Up Studies
Hearing
Humans
Mastoid*
Methods
Otitis
Otitis Media
Physiology
Skin
Adhesives

Figure

• 

  Fig. 1. Schematic drawings of the procedure: modified canal wall down mastoidectomy and mastoid obliteration using autologous materials. (A) A complete mastoidectomy is performed. (B) The antrum and epitympanic space superior to the tympanic segment of the facial nerve are obliterated with crushed cartilage harvested from concha cartilage. (C) Bone pate is used to smooth the mastoid bowl. (D) The remaining mastoid cavity is obliterated with an extended inferior based flap (IBF). (E) A temporalis muscle fascia graft is placed on the IBF and reconstruction of the tympanic membrane is performed.

• 

  Fig. 2. The postoperative air-bone gap values among patients with various disease patterns. The number above each bar represents the number of patients. HL, hearing level. *P<0.05.

• 

  Fig. 3. Pre- and postoperative findings in a patient with chronic otitis media in the left ear. (A) A preoperative finding of a perforated left anterior drum. (B) A computed tomography scan obtained before surgery shows chronic otitis media in the left ear (blue lines; right ear, red lines). (C) Preoperative audiometry shows an air-bone gap in the left ear. (D) One-year postoperative external auditory canal findings after posterior wall reconstruction and mastoid obliteration. (E) One-year postoperative audiometry shows improvement in the air-bone gap in the left ear.

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  Fig. 4. Pre- and postoperative findings in a patient with a cholesteatoma in the right ear. (A) A preoperative finding of attic destruction in the right ear. (B) A computed tomography scan obtained before surgery shows a cholesteatoma in the right ear. (C) Preoperative audiometry shows an air-bone gap in the right ear (red lines; left ear, blue lines). (D) The external auditory canal is well maintained postoperatively, 1 year after posterior wall reconstruction and mastoid obliteration. (E) One-year postoperative audiometry shows an improvement in the air-bone gap in the right ear.

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  Fig. 5. A retroauricular skin depression is commonly observed in patients after modified canal wall down mastoidectomy and mastoid obliteration using autologous materials. The retroauricular skin depression (arrow, A) was minor, which presented no cosmetic problem (B).

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