Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes
ObjectivesThe primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compar...
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| Format: | Article |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1381481/full |
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| author | Chiara Erfurt Chiara Erfurt Sanne F. Westerhout Sanne F. Westerhout Louise V. Straatman Louise V. Straatman Adriana L. Smit Adriana L. Smit Robert J. Stokroos Robert J. Stokroos Hans G. X. M. Thomeer Hans G. X. M. Thomeer |
| author_facet | Chiara Erfurt Chiara Erfurt Sanne F. Westerhout Sanne F. Westerhout Louise V. Straatman Louise V. Straatman Adriana L. Smit Adriana L. Smit Robert J. Stokroos Robert J. Stokroos Hans G. X. M. Thomeer Hans G. X. M. Thomeer |
| author_sort | Chiara Erfurt |
| collection | DOAJ |
| description | ObjectivesThe primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques.MethodsA retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1–2.2) vs. 2.0 years (IQR 1.2–3.1) (p = 0.013).Intervention(s)All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma.Main outcome measure(s)The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing.ResultsIn this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903).ConclusionsBased on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups. |
| first_indexed | 2024-04-24T12:32:09Z |
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| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-24T12:32:09Z |
| publishDate | 2024-04-01 |
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| series | Frontiers in Surgery |
| spelling | doaj.art-b0860d788eaf4c419a35daa3d0235b1c2024-04-08T04:27:31ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2024-04-011110.3389/fsurg.2024.13814811381481Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomesChiara Erfurt0Chiara Erfurt1Sanne F. Westerhout2Sanne F. Westerhout3Louise V. Straatman4Louise V. Straatman5Adriana L. Smit6Adriana L. Smit7Robert J. Stokroos8Robert J. Stokroos9Hans G. X. M. Thomeer10Hans G. X. M. Thomeer11Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center, University Medical Center Utrecht, Utrecht, NetherlandsObjectivesThe primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques.MethodsA retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1–2.2) vs. 2.0 years (IQR 1.2–3.1) (p = 0.013).Intervention(s)All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma.Main outcome measure(s)The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing.ResultsIn this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903).ConclusionsBased on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.https://www.frontiersin.org/articles/10.3389/fsurg.2024.1381481/fullcholesteatomarecurrent diseasetympanomastoidectomymastoid obliterationhearing lossmiddle ear disease |
| spellingShingle | Chiara Erfurt Chiara Erfurt Sanne F. Westerhout Sanne F. Westerhout Louise V. Straatman Louise V. Straatman Adriana L. Smit Adriana L. Smit Robert J. Stokroos Robert J. Stokroos Hans G. X. M. Thomeer Hans G. X. M. Thomeer Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes Frontiers in Surgery cholesteatoma recurrent disease tympanomastoidectomy mastoid obliteration hearing loss middle ear disease |
| title | Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| title_full | Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| title_fullStr | Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| title_full_unstemmed | Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| title_short | Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| title_sort | canal wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes |
| topic | cholesteatoma recurrent disease tympanomastoidectomy mastoid obliteration hearing loss middle ear disease |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1381481/full |
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