Surgical outcome of canal wall down mastoidectomy with or without cavity obliteration

Mohammad Shamsul Alam; M. Mazharul Shaheen; M. Sahbub Alam; Mohammad Mostafizur Rahman; Tanni Kundu Tanu

doi:10.18203/2320-6012.ijrms20262648

Authors

Mohammad Shamsul Alam Department of ENT and Head-Neck Surgery, 250 Bed General Hospital, Bhola, Bangladesh
M. Mazharul Shaheen Department of ENT and Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
M. Sahbub Alam Department of ENT, National Institute of ENT (NIENT), Dhaka, Bangladesh
Mohammad Mostafizur Rahman Department of ENT, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
Tanni Kundu Tanu Department of Public Health, North South University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20262648

Keywords:

Cholesteatoma, Mastoidectomy, Obliteration

Abstract

Background: Canal wall down (CWD) mastoidectomy is commonly used to treat chronic otitis media with cholesteatoma. Cavity obliteration may improve postoperative outcomes by reducing cavity-related complications. Aim of the study was to compare surgical outcomes of CWD mastoidectomy with and without cavity obliteration.

Methods: This prospective longitudinal observational study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, from July 2023 to June 2024. Eighty patients with active squamous chronic otitis media undergoing CWD mastoidectomy were enrolled. Group I had no obliteration; group II underwent obliteration using vascularized periosteo-temporofascial swing, bone dust, and cartilage. Outcomes included cavity discharge, giddiness, epithelialisation, wax formation, hearing, meatal stenosis, residual cholesteatoma, and facial nerve palsy.

Results: Mean age was comparable (27.92±8.23 versus 27.28±8.19 years; p=0.724), with male predominance in both groups. At three months, dry cavity was achieved in 95.0% of group II versus 72.5% of group I (p=0.015). Persistent giddiness was lower in group II (2.5%) than group I (20.0%). Complete epithelialisation occurred in 90.0% of group II versus 60.0% of group I (p=0.004). Wax formation was lower in group II (5.0%) than group I (20.0%). Postoperative hearing was significantly better in group II (45.82±5.38 dB versus 48.22±4.07 dB; p=0.027), with greater hearing gain (10.22±5.42 dB versus 7.95±3.68 dB; p=0.031). Meatal stenosis and residual cholesteatoma were less frequent in group II, and no facial nerve palsy occurred.

Conclusions: Cavity obliteration in CWD mastoidectomy provides better postoperative outcomes, including improved cavity healing, reduced complications, and superior hearing improvement.

References

Watkinson JC, Clarke RW, Thomas S, eds. Scott-Brown’s Otorhinolaryngology and Head and Neck Surgery. 8th edn. Boca Raton, FL: CRC Press; 2018.

Sharma K, Manjari M, Salaria N. 2013. Middle ear cleft in chronic otitis media: a clinicohistopathological study. Indian J Otolaryngol Head Neck Surg. 2013;65:493-7.

Mansoor T, Musani MA, Khalid G, Kamal M. Pseudomonas aeruginosa in chronic suppurative otitis media: sensitivity spectrum against various antibiotics in Karachi. J Ayub Med Coll Abbottabad, 2009;21(2):120-3.

Parisier SC, Green RP, Chute PM, Calhoun WF, Som PM. Surgical therapy of chronic mastoiditis with cholesteatoma. Otolaryngol Head Neck Surg. 1982;90(6):767-72.

Walker PC, Mowry SE, Hansen MR, Gantz BJ. 2014. Long-term results of canal wall reconstruction tympanomastoidectomy. Otol Neurotol. 2014;35(1):e24-30.

Mehta RP, Harris JP. Mastoid obliteration. Otolaryngologic Clin North Am. 2006;39(6):1129-42.

Beales, P.H., 1959. The problems of the mastoid cavity. J Larynol Otol, 73, pp.527-531.

Males AG, Gray RF. Mastoid surgery: quantifying the distress in a radical cavity. Clin Otolaryngol. 1994;19:194-8.

Ojala K, Sorri M, Sipilä P, Palva A. Late changes in ear canal volumes after mastoid obliteration. Arch Otolaryngol. 1982;108(4):208-9.

Yung M, Bennett A. 2013. Use of mastoid obliteration techniques in cholesteatoma. Curr Opin Otolaryngol Head Neck Surg. 2013;21(5):455-60.

Bhardwaj H, Amin S, Bhardwaj Y, Mahmood T, Raj D. Comparison of outcomes of open mastoid cavity- with or without obliteration. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4341-4.

Das C, Hazra TK. Relook on mastoid cavity obliteration: a prospective study. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 2):1107-14.

Kim BG, Kim HJ, Lee SJ, Lee E, Lee SA, Lee JD. Outcomes of modified canal wall down mastoidectomy and mastoid obliteration using autologous materials. Clin Experiment Otorhinolaryngol. 2019;12(4):360-6.

Liu SC, Wang CH, Huang BR. Obliteration of radical cavities and total reconstruction procedure without staging after canal wall down mastoidectomy: long-term results. Clin Experiment Otorhinolaryngol. 2015;8(3):230.

Sade J, Babiacki A, Pinkus G. The metaplastic and congenital origin of cholesteatoma. Acta Oto-Laryngol. 1983;96(1-2):119-29.

Maheshwari S, Kumar R, Nagle SK. Comparative study of quality of life and surgical outcome in open mastoid cavity and mastoid cavity obliteration in canal wall down mastoidectomy. Int J Otorhinolaryngol Head Neck Surg. 2023;9(6):444-50.

Deshmukh S, Sharma A, Dabholkar J. Mastoid cavity obliteration: our experience. Otolaryngol Polska. 2012;66(6):379-81.

Chhapola S, Matta I. Mastoid obliteration versus open cavity: a comparative study. Indian J Otolaryngol Head Neck Surg. 2014;66:207-13.