Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique

Abstract

In this retrospective study, we analyzed the functional results after using the retrograde mastoidectomy technique for cholesteatoma removal in an adult patient population. The described technique was used at a tertiary referral center for cholesteatoma removal in 218 adult patients, representing 242 operated ears, with an average follow-up time of 20.3 months. With the retrograde mastoidectomy technique, the cholesteatoma is removed posteriorly through the canal wall, from the epitympanic region toward the mastoid, with the option to reconstruct the posterior bony canal wall or create an open mastoid cavity, depending on the size of the defect. Primary surgery was carried out in 58.7 % ears, with the remaining 41.3 % representing revision surgery. In 151 cases, the posterior canal wall was reconstructed, and in 91 cases a classical CWD with an open mastoid cavity was created. In the majority of the cases (n = 213, 88.0 %), a primary hearing restoration was performed. There were 18 recurrences (12.7 %) in primary cases and 22 recurrences (22 %) in revision surgeries. Ninety percent of the recurrences (36 of 40 cases) occurred within 5 years. A postoperative air-bone gap of less than 20 dB was achieved in 61.6 % of the operated ears. Ears with a reconstructed posterior canal wall had significantly better hearing results than those cases in which a CWD procedure was used (air-bone gap of 17.6 versus 22.5 dB, p < 0.05). The retrograde mastoidectomy technique for cholesteatoma removal resulted in satisfying hearing results in the majority of the cases, with a recurrence rate comparable to the current literature.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Aslan Felek S, Islam A, Celik H et al (2009) The functional and anatomical results of the canal wall down tympanoplasty in extensive cholesteatoma. Acta Otolaryngol 129:1388–1394

    PubMed  Article  Google Scholar 

  2. 2.

    Dornhoffer JL (2004) Retrograde mastoidectomy with canal wall reconstruction: a follow-up report. Otol Neurotol 25:653–660

    PubMed  Article  Google Scholar 

  3. 3.

    Grewal DS, Hathiram BT, Saraiya SV (2007) Canal wall down tympanomastoidectomy: the ‘on-disease’ approach for retraction pockets and cholesteatoma. J Laryngol Otol 121:832–839

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Haginomori S, Takamaki A, Nonaka R et al (2009) Postoperative aeration in the middle ear and hearing outcome after canal wall down tympanoplasty with soft-wall reconstruction for cholesteatoma. Otol Neurotol 30:478–483

    PubMed  Article  Google Scholar 

  5. 5.

    Roth TN, Haeusler R (2009) Inside-out technique cholesteatoma surgery: a retrospective long-term analysis of 604 operated ears between 1992 and 2006. Otol Neurotol 30:59–63

    PubMed  Article  Google Scholar 

  6. 6.

    Sanna M, Facharzt AA, Russo A et al (2009) Modified Bondy’s technique: refinements of the surgical technique and long-term results. Otol Neurotol 30:64–69

    PubMed  Article  Google Scholar 

  7. 7.

    Stankovic M (2007) Follow-up of cholesteatoma surgery: open versus closed tympanoplasty. ORL J Otorhinolaryngol Relat Spec 69:299–305

    PubMed  Article  Google Scholar 

  8. 8.

    Jansen C (1968) The combined approach for tympanoplasty (report on 10 years’ experience). J Laryngol Otol 82:779–793

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Tos M (1995) Classic intact canal wall mastoidectomy. In: Tos M (ed) Manual of middle ear surgery, vol 2., Mastoid surgery and reconstructive proceduresThieme, Stuttgart New York, pp 106–155

    Google Scholar 

  10. 10.

    Mcrackan TR, Abdellatif WM, Wanna GB et al (2011) Evaluation of second look procedures for pediatric cholesteatomas. Otolaryngol Head Neck Surg 145:154–160

    PubMed  Article  Google Scholar 

  11. 11.

    Mishiro Y, Sakagami M, Kitahara T et al (2008) The investigation of the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis. Otol Neurotol 29:803–806

    PubMed  Article  Google Scholar 

  12. 12.

    Chang CC, Chen MK (2000) Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma. J Otolaryngol 29:270–273

    PubMed  Google Scholar 

  13. 13.

    Bizakis JG, Chimona TS, Hajiioannou JK et al (2006) Canal wall down mastoidectomy for cholesteatoma: experience at the University of Crete. J Otolaryngol 35:48–52

    PubMed  Article  Google Scholar 

  14. 14.

    Hakuba N, Hato N, Shinomori Y et al (2002) Labyrinthine fistula as a late complication of middle ear surgery using the canal wall down technique. Otol Neurotol 23:832–835

    PubMed  Article  Google Scholar 

  15. 15.

    Deveze A, Rameh C, Puchol MS et al (2010) Rehabilitation of canal wall down mastoidectomy using a titanium ear canal implant. Otol Neurotol 31:220–224

    PubMed  Article  Google Scholar 

  16. 16.

    Dornhoffer JL (2000) Retrograde mastoidectomy with canal wall reconstruction: a single-stage technique for cholesteatoma removal. Ann Otol Rhinol Laryngol 109:1033–1039

    CAS  PubMed  Google Scholar 

  17. 17.

    Plester D, Hildmann H, Steinbach E (1989) Atlas der Ohrchirurgie. Kohlhammer, Stuttgart

    Google Scholar 

  18. 18.

    Hildmann H (1991) Open or closed technique of tympanoplasty. Comments on saving the posterior wall of the auditory canal. Laryngorhinootologie 70:335–339

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    (1995) Committee on Hearing and Equilibrium Guidelines for the Evaluation of Results of Treatment of Conductive Hearing Loss. American Academy of Otolaryngology-Head and Neck Surgery Foundation I Otolaryngol Head Neck Surg 113:186–187

  20. 20.

    Hildmann H, Sudhoff H, Jahnke K (2004) Principles of an individual approach to cholesteatoma surgery. In: Jahnke K (ed) Current topics in otolaryngology-head and neck surgery. middle ear surgery. recent advances and future directions. Thieme, New York, pp 73–93

    Google Scholar 

  21. 21.

    Dornhoffer JL (2006) Cartilage tympanoplasty. Otolaryngol Clin North Am 39:1161–1176

    PubMed  Article  Google Scholar 

  22. 22.

    Cody DT, Mcdonald TJ (1984) Mastoidectomy for acquired cholesteatoma: follow-up to 20 years. Laryngoscope 94:1027–1030

    CAS  PubMed  Google Scholar 

  23. 23.

    Hinohira Y, Yanagihara N, Gyo K (2007) Improvements to staged canal wall up tympanoplasty for middle ear cholesteatoma. Otolaryngol Head Neck Surg 137:913–917

    PubMed  Article  Google Scholar 

  24. 24.

    Nyrop M, Bonding P (1997) Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol 111:521–526

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Haginomori S, Takamaki A, Nonaka R et al (2008) Residual cholesteatoma: incidence and localization in canal wall down tympanoplasty with soft-wall reconstruction. Arch Otolaryngol Head Neck Surg 134:652–657

    PubMed  Article  Google Scholar 

  26. 26.

    Smyth GD, Dowe AC (1971) Cartilage canalplasty. Laryngoscope 81:786–792

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Perkins R (1976) Tympanomastoid reconstruction: an operative procedure for anatomical and functional restoration of the radicalized ear. Laryngoscope 86:416–430

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Migirov L, Tal S, Eyal A et al (2009) MRI, not CT, to rule out recurrent cholesteatoma and avoid unnecessary second-look mastoidectomy. Isr Med Assoc J 11:144–146

    PubMed  Google Scholar 

  29. 29.

    Profant M, Slavikova K, Kabatova Z et al (2012) Predictive validity of MRI in detecting and following cholesteatoma. Eur Arch Otorhinolaryngol 269:757–765

    PubMed  Article  Google Scholar 

  30. 30.

    Koitschev A, Behringer P, Bogner D et al. (2012) Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol

  31. 31.

    Black B (2003) Reporting results in ossiculoplasty. Otol Neurotol 24:534–542

    PubMed  Article  Google Scholar 

  32. 32.

    Neudert M, Zahnert T, Lasurashvili N et al (2009) Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies. Otol Neurotol 30:332–338

    PubMed  Article  Google Scholar 

  33. 33.

    Stankovic MD (2008) Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors. Otol Neurotol 29:933–940

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Amir Minovi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Minovi, A., Venjacob, J., Volkenstein, S. et al. Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique. Eur Arch Otorhinolaryngol 271, 495–501 (2014). https://doi.org/10.1007/s00405-013-2452-x

Download citation

Keywords

  • Cholesteatoma
  • Surgery
  • Canal wall down
  • Mastoidectomy