Total mastoid obliteration in staged canal-up tympanoplasty for cholesteatoma facilitates tympanic aeration.

OBJECTIVE: To assess middle ear aeration after total mastoid obliteration using bone pate and hydroxyapatite performed at the second stage of intact-canal-wall (ICW) tympanoplasty.

STUDY DESIGN: Retrospective study.

SETTING: Tertiary referral hospital.

PATIENTS: Forty-two ears with cholesteatoma underwent the obliteration. Computed tomography (CT) scan 1 week before the second-stage operation showed disturbance of middle ear aeration.In the 27 ears of these cases, temporal bone CT scans taken 3 years or more after the operation were available.

INTERVENTION: We performed second-stage ICW tympanoplasty 1 year after the first-stage canal-up operation. After mastoidectomy and ossiculoplasty, communication between the tympanic cavity and antrum was blocked with cartilage flaps, and the antrum and mastoid cavity were obliterated totally with bone pate alone or combined with hydroxyapatite granules.

MAIN OUTCOME MEASURES: Otomicroscopic and otoendoscopic assessment for ear drum retraction was graded. Tympanic aeration assessed with CT when available.

RESULTS: After the total mastoid obliteration in the second-stage ICW tympanoplasty, no postoperative complications nor residual cholesteatoma were encountered. The incidence of ear drum retraction was significantly correlated with the grade of tympanic aeration.

CONCLUSION: The total mastoid obliteration done at the second-stage ICW tympanoplasty is a safe procedure that facilitates aeration of the tympanic cavity. In ears with restored tympanic aeration, the probability of a retraction pocket development is low. On the contrary, possibility of retraction pocket development is high in the ears with poor tympanic aeration after the second-stage operation.