Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket.
OBJECTIVE
To evaluate the surgical outcome in patients who have undergone mastoid and epitympanic obliteration technique.


METHODS
: Retrospective review.


METHODS
Tertiary care referral center.


METHODS
The study group included 151 patients with cholesteatoma who underwent mastoid and epitympanic obliteration technique. This technique was applied to cases who had a strong chance of recurrent retraction pocket and cholesteatoma formation, including those patients with an adhesive drum indicating poor eustachian tube function (n = 52) and patients with a destructive scutum (n = 68). Thirty-one patients had both an adhesive drum and a destructive scutum.


METHODS
The connection between the mastoid cavity and the middle ear was blocked by obliterating the epitympanum and antrum with bone pate and the remaining mastoid cavity with abdominal fat.


METHODS
The postoperative drum state, the incidence of retraction pocket formation and cholesteatoma recurrence, the surgical complications of obliteration, and the hearing outcome.


RESULTS
In 114 of 151 patients (75.4%), the middle ear was well healed and well aerated. The retraction pocket formation or cholesteatoma recurrence did not develop in any subject. Postauricular skin depression was the most common complication of this technique (n = 31 [20.5%]). In three patients (2.0%), the bone pate used for obliteration was infected. Of the 56 cases who underwent a staged operation to regain their hearing, 37 resulted in a postoperative air-bone gap less than 20 dB hearing level.


CONCLUSIONS
Mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patients with a poorly functioning eustachian tube or a defective scutum, while preserving the same advantage of the canal wall up technique.
Lee
Won Sang
WS
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea. wsleemd@yumc.yonsei.ac.kr
Choi
Jae Young
JY
Song
Mee Hyun
MH
Son
Eun Jin
EJ
Jung
Sang Ho
SH
Kim
Sung Huhn
SH
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D055502:Secondary Prevention; D013524:Surgical Flaps; D014433:Tympanoplasty / Q000379:methods*