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The bony obliteration tympanoplasty in cholesteatoma: safety, hygiene and hearing outcome: allograft versus autograft tympanic membrane reconstruction

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

To evaluate early results on hygiene, safety and functional outcome in a population undergoing a canal wall up technique with bony obliteration of the mastoid and epitympanic space (CWU-BOT) for extensive cholesteatoma, performed by a single surgeon. This study compares different techniques of tympanic membrane reconstruction, viz. allografts and autografts.

Patients

A consecutive series of 61 ears with acquired cholesteatoma treated with primary or revision CWU-BOT surgery from 2009 to 2014.

Intervention

Obliteration was performed by the use of cortical bone-chips and bone pâté. Patients were followed up with micro-otoscopy and MRI with diffusion-weighted imaging. Ossicular reconstruction was performed using a remodelled autologous or allogenic incus or malleus.

Main outcome measures

Residual and recurrence rate and short- and mid-term hearing outcome prior to any revision tympanoplasty were analysed, the effect of type of tympanic membrane reconstruction was considered.

Results

44 Ears were primary cholesteatoma cases, 17 cases were referred for revision surgery. Mean postoperative follow up was 45 months (SD 18.08) and mean follow-up until the last non-EP DW MRI 42 months (SD 17.72). Recurrent disease was present in 3%, no residual disease was present. An AC gain was seen in 75% of all ears undergoing ossicular reconstruction.

Conclusion

Reproducible safety, hygiene and hearing results with limited recurrence and residual disease can be obtained by younger otologic surgeons performing the BOT-CWU for extensive cholesteatoma while using a variety of grafts for tympano-ossicular reconstruction. The tympano-ossicular allograft nevertheless shows superior hearing results when a mobile intact stapes is present.

Level of evidence

Level 4

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Author notes

  1. Huibert F. van Waegeningh and Joost J. S. van Dinther contributed equally.

Authors and Affiliations

  1. European Institute for ORL-HNS, GZA Hospitals Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium

    Huibert F. van Waegeningh, Joost J. S. van Dinther, Robby Vanspauwen, Andrzej Zarowski & Erwin Offeciers

Authors
  1. Huibert F. van Waegeningh
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  2. Joost J. S. van Dinther
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  3. Robby Vanspauwen
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  4. Andrzej Zarowski
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  5. Erwin Offeciers
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Contributions

All authors contributed extensively to this work and both first authors contributed equally. HFvW and JJSvD conducted the data collection and wrote the main paper. RV, AZ and FEO have reviewed all stages and have substantially contributed to writing the manuscript. All authors discussed the results and implications and commented on the manuscript at all stages. No permission for re-use of material such as figures is required since all materials were created for this article by the authors.

Corresponding author

Correspondence to Huibert F. van Waegeningh.

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Conflict of interest

All authors declare they have no financial or non-financial competing interests or other interests that might be perceived to influence the interpretation of the article.

Ethical approval

All procedures performed in studies involving animals and human were in accordance with the ethical standards of the institution or practice at which the studies were conducted (Commissie Medische Ethiek GZA Toetsingskamer, Oosterveldlaan 22, 2610 Wilrijk, Belgium).

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van Waegeningh, H.F., van Dinther, J.J.S., Vanspauwen, R. et al. The bony obliteration tympanoplasty in cholesteatoma: safety, hygiene and hearing outcome: allograft versus autograft tympanic membrane reconstruction. Eur Arch Otorhinolaryngol 278, 1805–1813 (2021). https://doi.org/10.1007/s00405-020-06258-3

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