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Retrograde mastoidectomy with canal wall reconstruction versus intact canal wall tympanomastoidectomy for cholesteatoma with minimal mastoid extension

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

Abstract

Purpose

Appropriate reconstruction of the canal wall or maintenance of the middle ear pressure in cholesteatoma may help in preventing recurrence. Retrograde mastoidectomy with canal wall reconstruction (RMR) can overcome the challenge of a wider canal wall defect or temporal bone immaturity, which possibly increases the recurrence risk. This study compared the outcomes of RMR and intact canal wall tympanomastoidectomy (ICW) for cholesteatomas with minimal mastoid extension and quantitatively evaluate the relationship between anatomical features and recurrence.

Methods

This single-center retrospective cohort study included patients who had undergone primary ICW or RMR for pars flaccida cholesteatoma with minimal mastoid extension from 2009 to 2019. The main outcome measures were anatomical measurements of the shortest distance between the cranial fossa and the upper canal wall (SCU), attic volume, and bony defect area of the canal wall (BDC) on computed tomography; recidivism; and postoperative air–bone gap (ABG).

Results

There were no significant differences in the preoperative anatomical factors, recidivism incidence, and postoperative ABG between the RMR (n = 20) and ICW (n = 60) groups. However, the median BDC was significantly greater in the RMR group (58.3 vs. 37.0 mm2). There was no significant difference in the SCU and attic volume between patients with and without recurrence.

Conclusion

Selection of RMR or ICW may not affect recidivism and hearing outcomes in cholesteatoma with minimal mastoid extension. Bony defect size and attic narrowness were not associated with recurrence. Considering wider visualization and one-staged operation, RMR can be more adaptable than ICW for cholesteatoma with minimal mastoid extension.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available owing to privacy or ethical restrictions.

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Acknowledgements

We are grateful to Hiromi Sano, Tsunetaro Morino, and Sho Kurihara for data collection.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Masaomi Motegi, Yutaka Yamamoto, Taisuke Akutsu, Takahiro Nakajima, Masahiro Takahashi, Sayaka Sampei, Kazuhisa Yamamoto, Tomokatsu Udagawa, Yuika Sakurai & Hiromi Kojima

Authors
  1. Masaomi Motegi
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  2. Yutaka Yamamoto
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  3. Taisuke Akutsu
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  4. Takahiro Nakajima
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  5. Masahiro Takahashi
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  6. Sayaka Sampei
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  7. Kazuhisa Yamamoto
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  8. Tomokatsu Udagawa
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  9. Yuika Sakurai
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  10. Hiromi Kojima
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Contributions

Concept: MM, YY; design: MM, YY; supervision: HK; resource: YY, MT, YS; materials: TN, KY; data collection and/or processing: TN, SS, MT; analysis and/or interpretation: MM, YY, TA; literature search: MM; writing: MM, YY; critical reviews: YY, TU.

Corresponding author

Correspondence to Masaomi Motegi.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors alone are responsible for the content and writing of the manuscript.

Ethics approval

Approval was obtained from the institutional review board of The Jikei University School of Medicine (approval number: 32-205[10286]). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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The requirement for informed consent was waived owing to the retrospective nature of the study.

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Motegi, M., Yamamoto, Y., Akutsu, T. et al. Retrograde mastoidectomy with canal wall reconstruction versus intact canal wall tympanomastoidectomy for cholesteatoma with minimal mastoid extension. Eur Arch Otorhinolaryngol 279, 5113–5121 (2022). https://doi.org/10.1007/s00405-022-07351-5

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  • DOI: https://doi.org/10.1007/s00405-022-07351-5

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