Functional audiological outcomes of canal wall down mastoidectomy with type III tympanoplasty in middle ear and mastoid cholesteatoma
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20262801Keywords:
Cholesteatoma, Canal wall down mastoidectomy, Type III tympanoplasty, OssiculoplastyAbstract
Background: Cholesteatoma is a destructive middle ear disease requiring surgical intervention. Canal wall down mastoidectomy (CWDM) combined with type III tympanoplasty is commonly performed to eradicate disease and restore hearing. Objective of the study was to evaluate hearing outcomes and graft uptake in patients undergoing CWDM with type III tympanoplasty.
Methods: A prospective clinical study was conducted on 77 patients with attico-antral chronic suppurative otitis media. All patients underwent CWDM with type III tympanoplasty. Preoperative and postoperative hearing levels and air-bone gaps (ABG) were compared using the Wilcoxon signed-rank test.
Results: The median preoperative hearing loss improved from 43.75 dB to 31.25 dB postoperatively (p<0.001). Median ABG reduced from 22.5 dB to 8.75 dB (p<0.001). ABG closure of 10–19.9 dB was seen in 55.8% of patients.
Conclusions: CWDM with type III tympanoplasty provides significant hearing improvement along with effective disease eradication.
References
Kerckhoffs KGP, Kommer MBJ, van Strien THL, Visscher SJA, Bruijnzeel H, Smit AL, et al. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope. 2016;126(4):980-7.
van der Toom HFE, van der Schroeff MP, Pauw RJ. Single-stage mastoid obliteration in cholesteatoma surgery and recurrent and residual disease rates: a systematic review. JAMA Otolaryngol Head Neck Surg. 2018;144(5):440-6.
Tomlin J, Chang D, McCutcheon B, Harris J. Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol. 2013;18(3):135-42.
Merchant SN, McKenna MJ, Mehta RP, Ravicz ME, Rosowski JJ. Middle-ear mechanics of type III tympanoplasty (stapes columella): II. Clinical studies. Otol Neurotol. 2003;24(2):186-94.
Alleva M, Paparella MM, Morris MS, da Costa SS. The flexible/intact-bridge tympanomastoidectomy technique. Otolaryngol Clin North Am. 1989;22(1):41-9.
Filipo R, Barbara M. Rehabilitation of radical mastoidectomy. Am J Otol. 1986;7(3):248-52.
Amendola S, Falcioni M, Caylan R. Recurrent cholesteatoma in open vs closed technique tympanoplasties and its surgical management. In: Sanna M, editor. Cholesteatoma and Mastoid Surgery. Rome: CIC Edizioni Internazionali; 1997;654-9.
Sheehy JL, Brackmann DE, Graham MD. Cholesteatoma surgery: residual and recurrent disease. A review of 1024 cases. Ann Otol Rhinol Laryngol. 1977;86(4):451-62.
Nyrop M, Bonding P. Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol. 1997;111(6):521-6.
Ikeda M, Yoshida S, Ikui A, Shigihara S. Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity. J Laryngol Otol. 2003;117(4):249-55.
Kaylie DM, Gardner EK, Jackson CG. Revision chronic ear surgery. Otolaryngol Head Neck Surg. 2006;134(3):443-50.
Salman AA, Azhar H, Muhammad EK, Muhammad M. Analytical study of ossicular chain in middle ear cholesteatoma. Ann King Edward Med Coll. 2009;15(3):134-7.
Parisier SC, Edelstein DR, Han JC, Ahuja G. Management of labyrinthine fistulas caused by cholesteatoma. Otolaryngol Head Neck Surg. 1991;105(5):709-15.
Goyal R, Mourya A, Qureshi S, Sharma S. Modified radical mastoidectomy with type III tympanoplasty: revisited. Indian J Otolaryngol Head Neck Surg. 2016;68(1):52-5.
Kartush JM. Ossicular chain reconstruction: capitulum to malleus. Otolaryngol Clin North Am. 1994;27(4):689-715.
Kyrodimos E, Sismanis A, Santos D. Type III cartilage shield tympanoplasty: an effective procedure for hearing improvement. Otolaryngol Head Neck Surg. 2007;136(6):982-5.
Harvey SA, Lin SY. Double cartilage block ossiculoplasty in chronic ear surgery. Laryngoscope. 1999;109(6):911-4.
Ferlito S, La Mantia I, Merlino F, Cocuzza S, Di Stadio A, Cammaroto G, et al. Long-term anatomical and hearing outcomes of canal wall down tympanoplasty for tympano-mastoid cholesteatoma: a 20-year retrospective study. Life (Basel). 2022;12(11):1745.
Salem J, Bakundukize J, Milinis K, Sharma SD. Mastoid obliteration versus canal wall down or canal wall up mastoidectomy for cholesteatoma: systematic review and meta-analysis. Am J Otolaryngol. 2023;44(2):103751.
Acke F, Kostadinov F, Schlegel C, Linder T. Reconstructive ossiculoplasty options in primary cholesteatoma surgeries with an intact stapes. Eur Arch Otorhinolaryngol. 2024;281(2):711-8.
Mahesh SG, Sapna M, Tantry D, Bhandary R. Canal wall down approach for tympano-mastoid cholesteatoma: long-term results and prognostic factors. Indian J Otolaryngol Head Neck Surg. 2025;77(1):202-6.
Karkas A, Tinquaut F, Asimakopoulos A, Grondier B, Bertholon P, Abounaidane I. Auditory outcomes and predictors following ossiculoplasty in cholesteatoma surgery: a retrospective analysis. Front Surg. 2025;12:1630444.
Downloads
Published
How to Cite
Issue
Section
