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Successful obliteration of troublesome and chronically draining cavities

Published online by Cambridge University Press:  10 January 2017

S Geerse*
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
F A Ebbens
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
M J F de Wolf
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
E van Spronsen
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
*
Address for correspondence: Dr S Geerse, Department of Otorhinolaryngology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands E-mail: s.geerse@amc.nl

Abstract

Objective:

This study aimed to evaluate the results of revision radical cavity surgery with mastoid obliteration using a standardised grading scheme.

Methods:

A retrospective study was performed of 121 patients (122 ears) with chronically draining ears who underwent revision radical cavity surgery with mastoid obliteration between 2007 and 2013. Surgical indications, patient characteristics, pre- and post-operative Merchant grade, and surgical outcomes were recorded. The main outcome measures were presence of a dry ear, time for complete re-epithelialisation, presence of residual or recurrent disease, and need for revision surgery.

Results:

In the 5-year follow-up group (n = 31), dry ears were found in 97 per cent after 6 minor revisions and cholesteatoma-free ears were found in 97 per cent. In the total cohort, dry ears were found in 93 per cent after nine revisions and cholesteatoma-free ears were found in 98 per cent. The median time for complete re-epithelialisation was eight weeks. There were no major complications.

Conclusion:

In terms of the dry ear rate, residual cholesteatoma and time to complete epithelialisation, revision radical cavity surgery with mastoid obliteration produces very good results in concordance with published results, despite most patients suffering from very troublesome cavities prior to surgery.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Choi, SY, Cho, YS, Lee, NJ, Lee, J, Chung, WH, Hong, SH. Factors associated with quality of life after ear surgery in patients with chronic otitis media. Arch Otolaryngol Head Neck Surg 2012;138:840–5Google Scholar
2 Blake, C. The value of the blood-clot as a primary dressing in mastoid operations. The Journal of Laryngology, Rhinology, and Otology 1906;21:545–55Google Scholar
3 Yung, M, Smith, P. Mid-temporal pericranial and inferiorly based periosteal flaps in mastoid obliteration. Otolaryngol Head Neck Surg 2007;137:906–12Google Scholar
4 Yung, M, Bennett, A. Use of mastoid obliteration techniques in cholesteatoma. Otolaryngol Head Neck Surg 2013;21:455–60Google Scholar
5 Baumann, I, Gerendas, B, Plinkert, PK, Praetorius, M. General and disease-specific quality of life in patients with chronic suppurative otitis media: a prospective study. Health Qual Life Outcomes 2011;29:48 CrossRefGoogle Scholar
6 Jung, KH, Cho, YS, Hong, SH, Chung, WH, Lee, GJ, Hong, SD. Quality-of-life assessment after primary and revision ear surgery using the chronic ear survey. Arch Otolaryngol Head Neck Surg 2010;136:358–65Google Scholar
7 Merchant, SN, Wang, P, Jang, CH, Glynn, RJ, Rauch, SD, McKenna, MJ et al. Efficacy of tympanomastoid surgery for control of infection in active chronic otitis media. Laryngoscope 1997;107:872–7Google Scholar
8 Van Spronsen, E, Geerse, S, Mirck, PG, Van der Baan, S, Fokkens, WJ, Ebbens, FA. The shape of the osseous external auditory canal and its relationship to chronic external otitis. Otol Neurotol 2014;35:1790–6Google Scholar
9 Van Spronsen, E, Ebbens, FA, Mirck, PG, Van Wettum, CH, van der Baan, S. Canalplasty: the technique and the analysis of its results. Am J Otolaryngol 2013;34:439–44CrossRefGoogle ScholarPubMed
10 Mirck, PG. The M-meatoplasty of the external auditory canal. Laryngoscope 1996;106:367–9Google Scholar
11 Ahn, JH, An, YS, Bae, JS, Kim, DY. Postoperative results of tympanoplasty with mastoidectomy in elderly patients with chronic otitis media. Ann Otol Rhinol Laryngol 2012;121:168–73Google Scholar
12 Saito, T, Tanaka, T, Tokuriki, M, Shibamori, Y, Yamamoto, T, Noda, I et al. Recent outcome of tympanoplasty in the elderly. Otol Neurotol 2001;22:153–7Google Scholar
13 Charachon, R, Gratacap, B, Tixier, C. Closed versus obliteration technique in cholesteatoma surgery. Am J Otolaryngol 1988;9:286–92Google ScholarPubMed
14 Solomons, NB, Robinson, JM. Obliteration of mastoid cavities using bone pate. J Laryngol Otol 1988;102:783–4Google Scholar
15 Hartwein, J, Hörmann, K. A technique for the reconstruction of the posterior canal wall and mastoid obliteration in radical cavity surgery. Am J Otolaryngol 1990;11:169–73Google Scholar
16 Saunders, JE, Shoemaker, DL, McElveen, JT Jr. Reconstruction of the radical mastoid. Am J Otolaryngol 1992;13:465–9Google Scholar
17 Palva, T, Mäkinen, J. The meatally based musculoperiosteal flap in cavity obliteration. Arch Otolaryngol 1979;105:377–80CrossRefGoogle ScholarPubMed
18 Black, B, Kelly, S. Mastoidectomy reconstruction: revascularizing the canal wall repair. Am J Otol 1994;15:91–5Google Scholar
19 Popper, O. Periosteal flap grafts in mastoid operations. S Afr Med J 1935;17:77–8Google Scholar
20 O'Sullivan, PG, Atlas, MD. Use of soft tissue vascular flaps for mastoid cavity obliteration. Laryngoscope 2004;114:957–9Google Scholar
21 Singh, V, Atlas, M. Obliteration of the persistently discharging mastoid cavity using the middle temporal artery flap. Otolaryngol Head Neck Surg 2007;137:433–8Google Scholar
22 Mahendran, S, Yung, M. Mastoid obliteration with hydroxyapatite cement: the Ipswich experience. Otol Neurotol 2004;25:1921 Google Scholar
23 Berçin, S, Kutluhan, A, Bozdemir, K, Yalçiner, G, Sari, N, Karamese, O. Results of revision mastoidectomy. Acta Otolaryngol 2009;129:138–41Google Scholar
24 Van Spronsen, E, Van Waegeningh, HF, Geerse, S, Fokkens, WJ, Ebbens, FA. Shape of the osseous external auditory canal and its relationship to troublesome cavities. Laryngoscope 2016;126:693–8CrossRefGoogle ScholarPubMed