title: Reversible canal wall down mastoidectomy for acquired cholesteatomas: preliminary results.
abstract: OBJECTIVE
  The educational objectives were to discuss a new technique to manage acquired cholesteatomas and to compare this with standard approaches used for cholesteatoma removal. The study objective was to determine the feasibility of using a new approach, the reversible canal wall down approach, in conjunction with bone cement to remove acquired cholesteatomas and, potentially, preserve the ossicular chain.
  
  
  METHODS
  Retrospective review of five patients who underwent resection of their acquired cholesteatomas using a technique that maximizes exposure, yet preserves the posterior canal wall and, potentially, the ossicular chain.
  
  
  METHODS
  In the setting of a tertiary otological referral center, five consecutive patients with acquired cholesteatomas underwent reversible canal wall down surgery. Four patients were male (ages, 41, 53, 26, and 10 y), and one patient was a woman [age, 51 y]). A reversible canal wall down mastoidectomy approach was used in the patients. Main outcome measures were intraoperative findings with respect to cholesteatoma removal and postoperative clinical examination, including postoperative audiograms.
  
  
  RESULTS
  Five patients had dry ears postoperatively. One patient initially had granulation tissue forming on the posterior ear canal. This eventually resolved. The patients who had a postoperative audiogram after cholesteatoma resection with ossicular chain preservation noted an improvement or stabilization in their hearing.
  
  
  CONCLUSIONS
  Using the reversible canal wall down approach in conjunction with bone cement, one is able to obtain excellent exposure of the cholesteatoma and, potentially, preserve the ossicular chain. This approach may be particularly useful in revision cholesteatoma surgery or in cases of acquired cholesteatoma in which the surgeon may be able to preserve the ossicular chain.
authors.affiliation: Carolina Ear and Hearing Clinic, PC, Raleigh, NC 27612, USA. mcelveen-mail@carolinaear.com
authors.forename: John T
authors.initials: JT
authors.lastname: McElveen
authors.forename: Andy T A
authors.initials: AT
authors.lastname: Chung
mesh_terms: D000328:Adult; D001301:Audiometry, Pure-Tone; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D004424:Ear Canal / Q000601:surgery*; D004429:Ear Ossicles / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology