title: Long-term results of canal wall reconstruction tympanomastoidectomy.
abstract: OBJECTIVE
  This study was designed to evaluate the long-term results using the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma.
  
  
  METHODS
  Institutional review board-approved retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Retrospective review was performed on consecutive patients undergoing CWR tympanomastoidectomy with mastoid obliteration at a single institution from 1997 to 2011.
  
  
  METHODS
  Status of tympanic membrane and ear canal anatomy, preoperative and postoperative audiometry, residual cholesteatoma at second look surgery, postoperative complications, recurrence rate, and location.
  
  
  RESULTS
  Two hundred eighty-five ears in 273 patients underwent CWR tympanomastoidectomy with a mean age of 35 years with average follow-up of 4.29 years (median, 3.16 yr). A second-look ossiculoplasty was performed in 253 (89%). Recurrent retraction pocket formation occurred in 34 ears (13%). A secondary endaural atticotomy only was required to improve access for debridement in 16 of these 34 ears (5.8% of total ears). Only 7 ears (2.6%) required a revision open cavity mastoidectomy (n = 5) or subtotal petrosectomy (n = 2) for recurrent cholesteatoma. Those undergoing second-look ossiculoplasty demonstrated a small improvement in preoperative versus postoperative air-bone gap (ABG), 28 dB versus 23 dB, respectively. Postoperative infection occurred in 16 patients (5.6%) with 1 patient requiring conversion to open cavity mastoidectomy.
  
  
  CONCLUSIONS
  A CWR tympanomastoidectomy provides excellent intraoperative exposure of the middle ear and mastoid without the long-term disadvantages of a canal wall down mastoidectomy. Long-term follow-up demonstrates that there were only 2.6% failures requiring conversion to an open cavity or subtotal petrosectomy.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Hospital and Clinic, Iowa City, Iowa, U.S.A.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Walker
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Mowry
authors.forename: Marlan R
authors.initials: MR
authors.lastname: Hansen
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Gantz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery*; D002908:Chronic Disease; D004424:Ear Canal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult