title: Retrograde mastoidectomy with canal wall reconstruction: a single-stage technique for cholesteatoma removal.
abstract: The goal of this retrospective study was to report the preliminary results of the retrograde mastoidectomy technique with canal wall reconstruction used as a primary treatment method for cholesteatoma. This synthesis of canal wall up (CWU) and canal wall down (CWD) techniques was performed in 70 patients (75 ears; 35 pediatric, 40 adult) with an average 45-month follow-up. Surgical intervention involved removal of a portion of the canal wall for exposure and extirpation of the cholesteatoma, followed by reestablishment of the canal wall during reconstruction in a single stage. This leaves the mucosa relatively undisturbed and limits the extent of canal wall removal, facilitating mastoid aeration and preservation of anatomy. Recurrent disease occurred in 5% of cases. The hearing improvement was statistically significant (p < .05), with an average preoperative 4-frequency pure tone average air-bone gap of 27.2 dB improving to 11.5 dB. No patient had a worsening of hearing. The surgery takes less time than traditional techniques, is reproducible and easily taught, and can be universally applied to all cholesteatoma patients as primary treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72205, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Dornhoffer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000601:surgery*; D004424:Ear Canal / Q000601:surgery*; D004429:Ear Ossicles / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement; D013506:Otologic Surgical Procedures / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index