title: Pediatric cholesteatoma: canal wall window alternative to canal wall down mastoidectomy.
abstract: OBJECTIVE
  A previous pilot series described a hybrid mastoidectomy technique, canal wall window (CWW), which substituted for the canal wall down (CWD) procedure and involved slitting the posterior canal wall. The current, larger series compares the results of the CWW procedure with conventional surgical techniques.
  
  
  METHODS
  Retrospective analysis of 78 pediatric ears.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  The mean patient age was 13.5 years.
  
  
  METHODS
  The data analyzed included ears later requiring conversion from CWW to CWD, dry/moist ear results, recidivation determined by two separate methods, and audiometric data statistically analyzed using independent-samples analysis (unpaired, two-tailed Student's t test).
  
  
  RESULTS
  First, of 42 CWW ear procedures, 6 (14%) later required conversion to CWD. Second, dry ear results were as follows: for CWW, 94%; for CWD, 92%; and for CWU (canal wall up), 90%. Third, recidivation determined at 1 year (standard rate) was, for CWW, 19.5%; for CWD, 0%; and for CWU, 7.7%; the at-risk calculation rate was, for CWW, 27%; for CWD, 0%; and for CWU, 8.3%. The 6-year recidivation rate for all three surgical techniques was 0%. 4). The mean preoperative-to-postoperative four-tone air-bone gap change was, for CWW, from 29.7 to 26.4 dB; for CWD, from 32.9 to 39.0 dB; and for CWU, from 21.0 to 25.2 dB (postoperative CWW to CWD, p < 0.005). A postoperative air-bone gap result of 0 to 20 dB was achieved as follows: with CWW, in 13 of 36 ears; with CWD, in 2 of 14 ears; and with CWU, in 9 of 22 ears.
  
  
  CONCLUSIONS
  Frequently, a CWW procedure can be substituted for a traditional CWD procedure. In the extended series, the CWW technique continued to provide hearing results similar to CWU rather than to CWD procedures in a young population who will bear the surgical outcome for many decades.
authors.affiliation: Pediatric Otolaryngology Service and Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Godinho
authors.forename: Syed H
authors.initials: SH
authors.lastname: Kamil
authors.forename: Jose N
authors.initials: JN
authors.lastname: Lubianca
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Keogh
authors.forename: Roland D
authors.initials: RD
authors.lastname: Eavey
mesh_terms: D000293:Adolescent; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000503:physiopathology / Q000601:surgery*; D004424:Ear Canal / Q000601:surgery*; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000592:standards; D012086:Reoperation; D012189:Retrospective Studies