Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma
Introduction
When presenting results of surgical treatment for cholesteatomatous chronic otitis media, a sufficiently long follow-up period is essential because, for instance, the recurrence rate of cholesteatoma has been found to be related to the length of observation time [1]. Although results of chronic ear surgery have been widely published in the otologic literature, there are few studies with prolonged follow-up. Kinney [2] evaluated 90 patients undergoing intact canal wall mastoidectomy for cholesteatoma after a mean follow-up of 9.2 years (range, 7–12 years) and found a cholesteatoma recurrence rate of 25%. Lau and Tos [3] reported a recurrence rate of 10% in patients with sinus cholesteatoma on average 9.75 years after mastoidectomy. The same authors [1] examined patients with attic cholesteatoma after a mean follow-up of 11 years (range, 3–21 years) and observed a recurrence rate of 6.3%. Kapur and Jayarmachandran [4] reported results of staged combined approach tympanoplasty in a series of 151 patients with cholesteatoma after a mean follow-up of 14.5 years (range, 5–23 years). They detected 40 failures (26.5%), 19 (47.5%) of the failures were due to attic retraction pockets and four (10%) due to large residual cholesteatomas.
The purpose of this study was to analyze results of canal wall down mastoidectomy (CWDM) in patients with cholesteatoma after a follow-up of 10 years.
Section snippets
Materials and methods
Between 1976 and 1988, 273 patients with cholesteatomatous chronic otitis media were subjected to CWDM as a primary operation in the Department of Otolaryngology, University Hospital of Kuopio, Finland. One hundred and thirty-six (50%) of them had a follow-up of at least 10 years and these 136 patients form the population of this study. In the remaining 137 patients, the follow-up period varied from 2 to 9 years (mean, 5.2 years). In the majority of these latter patients the follow-up had been
Results
There were 54 (40%) female patients and 82 (60%) male patients. Age distribution of patients at the time of the primary operation is shown in Fig. 1. Ten patients (7%) had been subjected to a planned second-stage operation 8–12 months after the primary mastoidectomy, the remaining 126 patients (93%) underwent one-stage CWDM.
At the time of surgery, 42 ears (31%) were dry and 94 ears (69%) were discharging or moist. In 60 ears (44%) the cholesteatoma originated from the attic area, in 54 ears
Discussion
Chronic otitis media with cholesteatoma is a potentially dangerous disease because it can lead to life-threatening intracranial complications. Cholesteatoma is also a burdensome disease for the patient. In this series, 28% of patients underwent two major operations and 3% even three, in addition to numerous visits at the out-patient department. The ideal treatment for cholesteatoma is an one-stage procedure which can completely eradicate the disease and prevent its recurrence.
Most studies on
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