Abstract
Cholesteatoma is a progressive destructive ear disease which can affect any age group. It has been found to be more severe in children and young adults. It erodes the surrounding bone of middle ear, mastoid and ossicles. It causes partial to total deafness, unpleasant smelling discharge, pain, tinnitus, vertigo and facial paralysis. It can even cause meningitis, brain abscess and death. The post-operative outcome of hearing, and the state of the reconstructed middle-ear cavity after concurrent and staged reconstruction of middle ear after canal wall down mastoidectomy was studied in 30 ears with middle-ear cholesteatoma. The reconstructed middle ear was re-aerated in 60.5 % of the cases, which was significantly higher than for the epitympanum (39.5 %). Tympanoplasty was successful in terms of hearing results in 68.9 % of all subjects and in 75.4 % of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 % for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p < 0.03) high incidence in ears with no re-aerated space in their reconstructed mastoid cavities. It was revealed that the post-operative outcome of this surgical technique was significantly related to the state of re-aeration of the reconstructed middle-ear cavity but not with either concurrent or staged reconstruction. Audiological results are same for both concurrent and staged reconstruction following canal wall down tympanomastoidectomy, and hence we reccommend that concurrent reconstruction is preferred in limited disease and staged reconstruction in severe disease.
Similar content being viewed by others
References
Browning G (2008) Scott-Brown’s otorhinolaryngology-head and neck surgery, vol 3, 7th edn. Hodder Arnold, London, p 3407 (Ch 237C)
Chole RA (1999) Ossiculoplasty with banked cartilage. Otolaryngol Clin North Am 27:717–726
Berenholz LP, Rizer FM, Burkey JM, Schuring AG, Lippy WH (2000) Ossiculoplasty in canal wall down mastoidectomy. Otolaryngol Head Neck Surg 123:30–33
Ikeda M, Yoshida S, Ikui A, Shigihara S (2003) Canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle ear cavity. J Laryngol Otol 117(4):249–255
Jahn AF (1989) Cholesteatoma: what is it, how did it get there, and how do we get rid of it? Otolaryngology clin North Am 22(5):847–857
Kim HH, Battista RA, Kumar A, Wiet RJ (2006) Should ossicular reconstruction be staged following tympanomastoidectomy. Laryngoscope 116:47–51
Sasakit T et al (2007) Results of hearing tests after total middle ear reconstruction. Acta Otorhinol 127(5):474–479
O’Reilly RC, Cass SP, Hirsch BE, Kamerer DB, Bernat RA, Poznanovic SP (2005) Ossiculoplasty using incus interposition: hearing results and analysis of the middle ear risk index. Otol Neurotol 26(5):853–858
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Ravishankar, C., Datta, R.K. Evaluation of Requirements for Staging the Procedure of Reconstruction of Middle Ear After Canal Wall Down Mastoidectomy. Indian J Otolaryngol Head Neck Surg 69, 155–158 (2017). https://doi.org/10.1007/s12070-016-0990-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-016-0990-4