Faculty Collaboration Database

Outcomes Following Modified Tympanomastoidectomy With Soft-wall Reconstruction. Otol Neurotol 2018 Oct;39(9):1139-1146

Date

08/15/2018

Pubmed ID

30106849

DOI

10.1097/MAO.0000000000001944

Scopus ID

2-s2.0-85056546795 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVE: To report outcomes following modified tympanomastoidectomy with soft-wall reconstruction (MTMSWR).

STUDY DESIGN: Retrospective cohort.

SETTING: Tertiary referral center.

PATIENTS: Forty-seven patients (48 ears) with aggressive cholesteatoma undergoing MTMSWR.

INTERVENTIONS: Canal wall down (CWD) tympanomastoidectomy with temporalis fascia reconstruction of the posterior external auditory canal (EAC).

MAIN OUTCOME MEASURES: Cholesteatoma recidivism; hearing outcomes; degree of soft-wall retraction; time to epithelialization; otorrhea.

RESULTS: All ears had some form of ossicular compromise. There were 41 ears with completed surveillance of which 39% demonstrated recidivism for cholesteatoma. Of these, 68.8% had a small cholesteatoma foci averaging 3.7 mm. Air pure-tone average remained stable or improved for 60.0% and declined ≤ 20 dB for 85.7%. Excluding ears unable to undergo ossicular chain reconstruction, final air-bone gap was ≤ 30 dB for 66.7%. Retraction of the reconstructed wall was absent-to-mild in 34.7% and moderate-to-full in 52.1%. Thirteen percent had soft-wall breakdown. Average time to full epithelialization of the wall was 58.5 days.

CONCLUSIONS: MTMSWR is an option for restoring the posterior EAC wall following CWD surgery. Recidivism is comparable to canal wall up surgery, and hearing outcomes are generally better than CWD. Other advantages include rapid epithelialization, low rates of otorrhea, and restoration of a self-cleaning EAC regardless of retraction into the mastoid cavity.

Author List

Doerfer KW, Friedland DR

Authors

Karl W. Doerfer MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin
David R. Friedland MD Associate Director, Director, Chief, Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Child
Cholesteatoma, Middle Ear
Cohort Studies
Ear Canal
Fascia
Female
Humans
Male
Mastoidectomy
Middle Aged
Retrospective Studies
Treatment Outcome
Tympanoplasty