title: Canal wall up tympanoplasty for cholesteatoma with intact stapes. Comparison of hearing results between cartilage and PORP on stapes and impact of malleus removal and total reinforcement of the tympanic membrane by cartilage.
abstract: OBJECTIVE
  To compare the results obtained with canal wall up (CWU) tympanoplasty for cholesteatoma using cartilage or an hydroxyapatite (HA) PORP positioned on the head of the stapes and to analyse the impact of malleus removal and total reinforcement of the tympanic membrane with cartilage.
  
  
  METHODS
  Retrospective study of 128 cases (99 adults, 29 children) operated between 2003 and 2012 for cholesteatoma by CWU tympanoplasty with use of a cartilage graft (90 cases) or a PORP (38 cases) on the head of the stapes. Audiometric results were analysed according to the International Bureau for Audiophonology (BIAP) criteria and were submitted to statistical analysis. All ossiculoplasties were performed during the first operation and only 39% of patients required surgical revision. The malleus was preserved in 79 cases and sacrificed in 49 cases.
  
  
  RESULTS
  With a follow-up of 2 years, the residual mean air-bone gap was 16.8 dB in the cartilage group (gain of 7.6 dB; P = 0.001) and 15.8 dB in the PORP group (gain of 8.5 dB; P = 0.002). The air-bone gap was less than 20 dB in 67.6% of cases in the cartilage group and 70.4% of cases in the PORP group. No significant difference was observed between the 2 techniques and no significant difference was observed according to whether or not the malleus was preserved in either the cartilage group or the PORP group.
  
  
  CONCLUSIONS
  These results confirm the value of cartilage graft placed on the head of the stapes as ossiculoplasty technique in cholesteatoma operated by CWU tympanoplasty, giving comparable results to those obtained with a PORP. Malleus removal did not induce any reduction of the quality of hearing obtained. Total reinforcement of the tympanic membrane with cartilage appeared to decrease the cholesteatoma recurrence rate (8.5%).
authors: Service ORL et de chirurgie cervicofaciale, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France. Electronic address: c.querat@yahoo.fr.
authors: C
authors: C
authors: Quérat
authors: Service ORL et de chirurgie cervicofaciale, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors: C
authors: C
authors: Martin
authors: Service ORL et de chirurgie cervicofaciale, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors: J-M
authors: JM
authors: Prades
authors: Service ORL et de chirurgie cervicofaciale, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors: C
authors: C
authors: Richard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008307:Malleus / Q000601:surgery; D008875:Middle Aged; D009998:Ossicular Prosthesis; D012189:Retrospective Studies; D013199:Stapes; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult
keywords: Autologous cartilage graft; Canal wall up tympanoplasty; Cholesteatoma; Malleus removal; PORP