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Outcomes Following Modified Tympanomastoidectomy With Soft-wall Reconstruction

Doerfer, Karl W.; Friedland, David R.

doi: 10.1097/MAO.0000000000001944
MIDDLE EAR AND MASTOID DISEASE

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.

Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin

Address correspondence and reprint requests to David R. Friedland, M.D., Ph.D., Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; E-mail: dfriedland@mcw.edu

Submitted in conjunction with accepted poster presentation for the American Otological Society Meeting at COSM, 2018.

The authors disclose no conflicts of interest.

Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company