title: Intraoperative findings of revision canal wall-down tympanomastoid surgery.
abstract: CONCLUSIONS
  Chronically discharging mastoid cavities had well-defined technical faults from previous surgery. Identifying and eliminating these errors during revision canal wall-down (CWD) tympanomastoidectomy converted troublesome mastoid cavities into safe ears in 84% of cases.
  
  
  OBJECTIVE
  To assess intraoperative findings of revision CWD tympanomastoidectomy to determine the most common causes of failure of previous surgery. The short-term results of revision surgery after a 12-month follow-up period were analyzed.
  
  
  METHODS
  The study group consisted of 50 consecutive patients, 27 males and 23 females, aged 7-63 years (mean 34 ± 17 years) undergoing revision CWD tympanomastoidectomy due to persistently discharging mastoid cavities. The outcome of revision surgery was measured semi-quantitatively using a grading system.
  
  
  RESULTS
  The most common causes for failure of previous surgery were persistent mastoid cells in the tegmental, sinodural angle, and the retrolabyrinthine, retrofacial, and mastoid tip regions (100%); the bony overhangs at the edges of the mastoid cavity and the high facial ridge (98%); inadequately narrow meatus (84%); recurrent or residual cholesteatoma (46%); and remaining malleus head (40%). Revision surgery included elimination of all encountered limitations followed by mastoid cavity obliteration in about two-thirds of cases. Hearing restoration was done in only 34% of ears. In the remaining cases, intact ossicular chain (6%), existing sufficient previous reconstruction (22%) or impossible situation for reconstruction (38%) was found.
authors.affiliation: Department of Otorhinolaryngology, Tartu University Hospital, Tartu, Estonia. priit.kasenomm@kliinikum.ee
authors.forename: Priit
authors.initials: P
authors.lastname: Kasenõmm
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult