Elsevier

Auris Nasus Larynx

Volume 27, Issue 3, July 2000, Pages 227-229
Auris Nasus Larynx

Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma

https://doi.org/10.1016/S0385-8146(99)00071-1Get rights and content

Abstract

Objective: To examine 10-year results of canal wall down mastoidectomy (CWDM) for acquired cholesteatoma. Methods: Medical records of 136 patients with cholesteatoma who has undergone CWDM in a university hospital and who had a follow-up of at least 10 years were checked. Results: During follow-up, 21% of patients had undergone one revision operation and 3% two revisions. The recurrence rate of cholesteatoma was 17% and in three patients the cholesteatoma recurred twice. Ten years after CWDM, 98% of the operated ears were dry, 1% moist, and one ear (0.7%) was discharging. The tympanic membrane was intact in 92% and perforated in 8%. Only 14% of patients had hearing levels of 20 dB or better and 46% had 40 dB or better. Conclusion: It is concluded that the surgical technique of CWDM should be improved in order to lower the recurrence rate and to improve hearing results.

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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There are more references available in the full text version of this article.

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