Modification Of Canal Wall Up Mastoidecotomy With Tympanoplasty For Cholesteatoma

mastoidectomy with stageⅠtympanoplasty in the treatment of middle ear cholesteatoma.Methods: We observed the31patients（31ears）who were treated with modified canalwall up mastoidectomy with tympanoplasty between Oct in2008and Sep in2011. All of thepatients were definitely diagnosed the middle ear cholesteatoma by otology examination andtemporal bone CT before surgery.By retroauricular incision，a cortical mastoidectomy and atticotomy was performed asthe approch of classic canal wall up mastoidectomy. After removal of cholesteatoma, drilledaway a part of lateral wall of the attic via meatus and such an extent could visualize theanerior part of the attic.Then removed the remnant pathological tissues from the attic viameatus and mastoid simultaneously. The ossicles were dealt accordingly. The canal wasenlarged by removing the anterior bony bulge,and then drilled away a portion of theposterior osseous annulus so as to expose the tympanic sinus and the stapes.After removal ofthe pathological tissuses, the one stage tympanoplasty was performed according to thesituation in the surgery. The auricular bone prosthesis was made of the autogeneic corticalbone or residual incus.At last covered the defect of lateral wall of the attic with fascia.We observed the dry ear time and studied the recovery of the external auditory canal,the graft and the postoperative complications. The postoperative hearing was examined3months later after the surgery. The last hearing result was analyzed by statistics. Theparameters were compared using t-test.Results:The patients were followed up between6months and40months after surgery.1.The dry ear time：The dry ear standard was that the exudation ceased completely. The dry ear time wascounted from the first day after the surgery. In our group the dry ear time was14~21daysand the mean time was18.0±1.2days.2.The modality and function of the external auditory canal：The modality of the external auditory canal was appreciably broad and straight. Thefunction of self-cleanness recovered gradually, and at the beginning there was some crust and secretion needed to be cleaned. About2months later it returned to the normal level.3.The healing of graft:All of the temporalis fascia were survival. There were no reperforations or atrophy ofthe tympanic membranes. Two ears which were observed with retraction from attic had notdeveloped into pockets yet.4.The postoperative hearing：11cases were treated by type Ⅲa，19cases by type Ⅲb and1case by typeⅠin our group.The mean postoperative ABG was (21.5±6.4） dBHL. In17cases the ABG was≤20dBHL,in13cases it was21～30dB dB HL and in1case it was>30dB.Surgical t reat mentwas fou nd to be effect ive in17cases (54.8%) when the criterion was that thepostoperative ABG was less than20dB.5. There were no the paralysis of the facial nerve, no labyrinthitis, no other encephalicand extracranial complications. The recurrence of the cholesteatoma and the hearingdecrease did not happen. Hydrops in the mastoid cavity was observed in one ear. Anothercase suffered from tinnitus constantly after operation.Conclusions:1. The postoperative hearing can be improved by this technique satisfactorily. The dryear appears quickly, and the crust can be avoided.2. The modified canal wall up mastoidectomy with stageⅠtympanoplasty can wipe offthe pathologic tissues thoroughly, so the recurrence of cholesteatoma decreases by thistechnique.Our research emphasizes that the reservation of the modality and function of themiddle ear and external auditory canal is very important. It accords with the faith ofmicro-trauma surgery and the orientation of functional surgery. The one stage technique canhelp to alleviate the patient,s economy burden. However, a further study should analyselong-term results of a larger patient group.