Mastoid and epitympanic bony obliteration in pediatric cholesteatoma

Jean-Philippe Vercruysse, Bert De Foer, Thomas Somers, Jan W Casselman, Erwin Offeciers
Otology & Neurotology 2008, 29 (7): 953-60

OBJECTIVE: The primary goal of cholesteatoma surgery is complete eradication of the disease. To lower the recurrence rate in the pediatric population in canal wall up techniques and to avoid the disadvantages of canal wall down techniques, the bony obliteration technique with epitympanic and mastoid obliteration has been developed. The objective of this study was to evaluate the long-term surgical outcome and recurrence rate of this technique in children.

STUDY DESIGN: Retrospective case review.

SETTING: : Tertiary referral center.

PATIENTS: Fifty-two children (<16 yr) were operated on in 90.4% (n = 47) for a primary or recurrent cholesteatoma and in 9.6% (n = 5) for an unstable cavity.

INTERVENTION: In all cases, we closed the tympanoattical barrier and the posterior tympanotomy with sculpted cortical bone and then completed obliteration of the epitympanum and mastoid with bone pâté. A reconstruction of the middle ear was performed by means of an allograft tympanic membrane including the malleus handle and a sculpted allograft malleus or incus for columellar reconstruction.

MAIN OUTCOME MEASURES: Recurrent rate; residual rate; functional outcome; hygienic status of the ear; long-term safety issues.

RESULTS: The mean follow-up time was 49.5 months (range, 12-101.3 mo). Recurrent cholesteatoma occurred in 1.9% (n = 1). Residual cholesteatoma was detected in 15.4% (n = 8) of the cases. Postoperative hearing results revealed a median gain on pure-tone averages of 14.3 dB and a median postoperative air-bone gap of 25.6 dB.

CONCLUSION: The mastoid and epitympanic BOT is an effective technique to lower the recurrence rate of cholesteatoma in the pediatric population. Follow-up by magnetic resonance imaging provides a safe, noninvasive method for postoperative detection of residual cholesteatoma.

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