Mastoid obliteration and reconstruction techniques:A review of the literature

Objective To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.Methods A PubMed(Medline)and LILACS databases as well as crossed references search was performed with the following Mesh terms:“cholesteatoma”,“cholesteatoma-middle ear”,“otitis media”,“otitis media,suppurative”,“mastoiditis”,“mastoidectomy”,“canal wall down mastoidectomy”,“radical mastoidectomy”,“mastoid obliteration”and crossed references.Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction.The technique and materials used,anatomic and functional results,complications,recurrence rates,and changes in quality of life,were analyzed.A total of 94 articles were screened,38 were included for full-text detailed review.Results Twenty-one articles fulfilled the inclusion criteria.Techniques and materials used for canal wall reconstruction,tympanoplasty,and ossiculoplasty were varied and included autologous,biosynthetic,or both.Auditory results were reported in 16 studies and were inconsistent.Three studies reported improvement in the quality of life using the GBI scale.Follow-up time ranged from 1 to 83 months.Eleven articles used imaging studies to evaluate postoperative disease recurrence.The highest recurrence rate reported for cholesteatoma after obliteration was 19%.The most frequently reported complications were retraction pockets and transient otorrhea.Conclusion Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems.So far,it is still not possible to standardize an ideal procedure.The available level of evidence for this topic is low and limited.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

Functional results of revision canal wall down mastoidectomy

In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 years)who underwent revision canal wall down mastoidectomy from March 2006 to March 2017 in the Department of Otology of the First Affiliated Hospital,Wenzhou Medical University,China.This study was approved by the Ethics Committee of the First Affiliated Hospital,Wenzhou Medical University,China(approval No.2008-05-02A11)on May 2,2008.The possible reasons for previous surgical failures were confirmed by the operative findings and included a narrow auditory meatus orifice(100%),recurrent or residual cholesteatoma(82%),high facial ridge(94%),residual air cells(47%),and labyrinthine fistula(12%).The mean time until achievement of dry ear after surgery was 5.8±2.4 weeks.After a mean 6-month follow-up,the mean postoperative air–bone gap decreased from 33.8±4.8 to 17.1±5.1dB in 30 patients who underwent mastoidectomy with simultaneous tympanoplasty.However,no significant postoperative hearing change had occurred in the other 4 patients with eustachian tube occlusion.All patients were followed up for>24 months with a disease-free dry ear and stable hearing results.The main reasons for lack of dry ears after mastoidectomy were a narrow auditory meatus orifice,recurrent or residual cholesteatoma,high facial ridge,and residual air cells.Early dry ear and hearing promotion are obtainable in most patients using revision canal wall down mastoidectomy.