Canal wall-down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma: focus on postoperative middle ear status^*

Abstract

Objectives: We reviewed surgical results of canal wall-down tympanoplasty (CWDT) with soft posterior meatal wall reconstruction (SWR) for acquired cholesteatoma (AC), and identified factors associated with surgical outcomes.

Methods: Results from 119 ears with AC (pars flaccida, n = 99; pars tensa, n = 20) that underwent CWDT with SWR were retrospectively reviewed. We defined postoperative balloon-like retraction (PBR) with web formation, which needed reoperation to clean accumulated cerumen, as postoperative deep retraction pocket (PDRP).

Results: Residual cholesteatoma was found in 11 ears (9.2%). Seven residual cholesteatomas were treated with outpatient operation. Seven ears (5.9%) showed PDRP. A transcanal approach was applied to all PDRPs. Postoperative mastoid reaeration was observed in 57 ears (47.9%). No factors significantly associated with residual cholesteatoma or PDRP were identified. The frequency of postoperative mastoid reaeration was significantly higher among cases with young age (<50 years), stage I cholesteatoma, or type I ossiculoplasty.

Conclusion: CWDT with SWR showed low rates of residual cholesteatoma or postoperative deep retraction pocket (PDRP). Most residual cholesteatomas and PDRPs could be dealt with using a minimally invasive procedure. Young age, stage I cholesteatoma, and type I ossiculoplasty were associated with postoperative mastoid reaeration. This procedure seems fully feasible for surgical treatment of AC.

Chinese abstract

目的：我们回顾了采用软后口壁重建术（SWR）治疗获得性胆脂瘤（AC）的耳道壁下鼓室成形术（CWDT）的手术结果, 并确定了与手术结果相关的因素。

方法：共119例患AC（同等松弛, n = 99；同等紧致, n = 20）的耳接受了采用SWR的CWDT治疗, 并对其进行回顾性分析。我们将带网形的术后气球状回缩 （PBR）定义为术后深缩回袋（PDRP）, 此回缩需要再次手术来清洁累积的耳垢。

结果：在11个耳中发现残余胆脂瘤（9.2％）。门诊手术治疗7例残余胆脂瘤。七个耳（5.9％）显示PDRP。经耳道法可应用于所有的PDRP。 57个耳（47.9％）中观察到术后乳突再生。未发现与残余胆脂瘤或PDRP显著相关的因素。年轻患者（<50岁）、I期胆脂瘤或I型骨性成形术患者的术后乳突再发生频率明显较高。

结论：采用SWR的CWDT治疗显示残留胆脂瘤低或术后深度缩回袋（PDRP）率低。大多数残余胆脂瘤和PDRP可以使用微创手术来处理。年轻、I期胆脂瘤和I型骨化成形术都与术后乳突再发生有关。这种手术似乎是完全可行的AC手术治疗法。

Keywords:

• Acquired cholesteatoma
• canal wall-down tympanoplasty with soft posterior meatal wall reconstruction
• surgical outcomes
• residual cholesteatoma
• postoperative deep retraction pocket

Disclosure statement

The authors report no financial interests, relationships, and affiliations relevant to the subject of the manuscript. The authors report no conflicts of interest.