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The Prevention of Recurrent Cholesteatoma in CWU Surgery: The Use of Titanium Sheeting

Black, Bruce*,†; Gutteridge, Ian*

doi: 10.1097/MAO.0000000000001530

Objective: Assessment of the outcomes of a technique of prevention of recurrent cholesteatoma in canal wall up (CWU) mastoidectomy, using titanium sheeting to repair the external auditory canal wall.

Patients: Sixty four cholesteatoma cases were managed during a period from 2007 to 2015. The cases were unselected; the surgery was performed by the senior author. Cholesteatoma Patterns Were: Forty two attic, nine pars tensa, seven combined attic-pars tensa, three congenital, and three other. Primary surgery was undertaken in 33 cases.

Interventions: All cases underwent CWU surgery that employed canal wall repair using fine titanium sheeting combined with overlying organic material to repair canal wall defects. Drum repairs employed cymba conchae cartilage-perichondrium composite grafts. Chain reconstruction used Spanner struts or Grace Alto PORPs or TORPS.

Results: Two cases suffered mesotympanic residual disease, and three, mesotympanic recurrence one of which extended into the attic. Two other cases incurred atticomastoid residues. Transient myringitis occurred in three cases.

Conclusion: The surgery was judged on its ability to avoid atticomastoid recurrence, and was regarded as highly successful. The titanium sheeting offers a relatively simple but effective technique. The mesotympanic complications are those also commonly found in both CWD and other CWU methods. As in other CWU procedures, the problems of the open cavity were avoided.

*Department of Otolaryngology, Lady Cilento Children's Hospital, Brisbane

Department of Surgery, University of Queensland, Queensland, Australia

Address correspondence and reprint requests to Bruce Black, M.D., F.R.A.C.S., F.R.C.S. (Ed), F.R.C.S., 6/101 Wickham Terrace, Spring Hill, Brisbane, Queensland 4000, Australia; E-mail:

There is no known conflict of interest relevant to the work.

Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company