Intraoperative findings of revision canal wall-down tympanomastoid surgery

Abstract

Conclusion: 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.

Keywords::

• Cholesteatoma surgery
• mastoid obliteration
• hearing results

Acknowledgments

The author would like to thank colleagues at the Department of Otorhinolaryngology, Tartu University Hospital, for their collaboration and Pille Kool for the statistical analysis in this paper.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.