[The clinical research on the canal wall up and canal wall down surgery in chronic suppurative otitis media].
OBJECTIVE
To investigate on the Indication and quality of life of the canal wall up and canal wall down surgery in chronic suppurative otitis media, to provide reference for surgical options.


METHODS
The clinical data of patients underwent canal wall up or canal wall down surgery are analyzed. Follow up on 312 patients are accomplished with pure tone audiometry, acoustic impedance for surgical cavity volume, ear endoscopy and the Chinese chronic ear survey (CCES).


RESULTS
(1) The dry ear rate of canal wall up and canal wall down surgery are 98.7% and 98.6% respectively (P > 0.05). (2) The average cavity epithelization and dry ear time are 40.1 +/- 21.2 days for canal wall up surgery and 53.5 +/- 15.0 days for canal wall down surgery (P < 0.05). The postoperative ear volume to the contralateral normal ear volume ratio are 1.16 +/- 0.10 for canal wall up surgery and 2.05 +/- 1.19 for canal wall down surgery (P < 0.05). (4) Score of the CCES: 91.2 +/- 6.8 points for canal wall up surgery and 72.0 +/- 7.7 for canal wall down surgery (P < 0.05). (5) The proportion of patients feeling change of ear appearance is 5.7% for canal wall up surgery and 80.8% for canal wall down surgery (P < 0.05). (6) Hearing after surgery: objective hearing improvement rate is 58.9% for canal wall up surgery and 24.2% for canal wall down surgery (P < 0.05) according to the questionnaire, while the pure tone audiometry shows no significant difference in hearing thresh hold and air-bone gap. (7) The satisfactory score after surgery is 9.55 points for canal wall up surgery and 8.11 points for canal wall down surgery (P < 0.05).


CONCLUSIONS
(1) Patients underwent canal wall up surgery have near-normal external ear morphology, shorter dry ear time and much higher quality of life compared to canal wall down surgery. (2) For experienced ear surgeon, the indication for canal wall up surgery can be extended to cases with diploetic or sclerotic type of mastoid and part of the cases with anatomical variation and intracranial or extracranial complications.
Department of Otorhinolaryngology-Head and Neck Surgery, Third Hospital of Peking University, Beijing 100191, China.
Yu
Y
Song
Furong
F
Ma
D000158:Acoustic Impedance Tests; D001301:Audiometry, Pure-Tone; D002908:Chronic Disease; D004424:Ear Canal / Q000033:anatomy & histology / Q000601:surgery*; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology; D006320:Hearing Tests; D006801:Humans; D010035:Otitis Media, Suppurative / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome