| Objective:To compare the effect of canal wall up mastoidectomy and canal wall down mastoidectomy combined with one-stage tympanoplasty.Method:The records of 85 cases (ears) treated for chronic suppurative otitis media (CSOM) and cholesteatoma at the Department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Zhejiang University of Medicine during the period from March 2011 to October 2013 were retrospectively reviewed. Canal wall up(CWU) mastoidectomy combined with one-stage tympanoplasty was done in another 25 cases (8 with cholesteatoma,17 with CSOM), and canal wall down(CWD) mastoidectomy combined with one-stage tympanoplasty was done in 60 cases (42 with cholesteatoma, 18 with CSOM), (in which 3 cases were changed from CWU to CWD). The length of follow-up ranged from 1 to 2 years. The ossicles lesion during surgery, the dry-up time, recovery of external auditory canal, graft uptake, or any complications after surgery were observed. Audiologic follow-uppost-operatively was since 3 months, and the latest hearing outcomes were used for analysis. Student x2 and t test were used for statistical analysis.Result:1. Intraoperative Observation Indicators:Relationship between the state of ossicles and operation options:The state of ossicles was not the main reason for operation options.2. Postoperative observation indicators:1) Dry-up time:No exudation of the external auditory canal was thought as dry ear, and duration of dryness was counted since the first day after surgery. The CWU group was within 3-7 weeks, and the CWD group was within 4-8 weeks.2) Appearance and function of external auditory canal:External auditory canals in CWU group owned normal appearance, self-cleaning of which always gradually recovered and reached to fully at about 2 months since surgery, also, there’s no need for regular ear cleaning. Compared to pre-operation, however, external auditory canals in CWD group became larger and straighter with basic normal appearance, and easier for checking. Existed little dry scabs and excretion for regular ear cleaning in the beginning, meanwhile this style of operation called for cavity cleaning per 6-12 months after surgery.3) Graft uptake:In our study, all temporal muscle fascia survived with no eardrum appeared atrophic or re-perforative. The eardrums in 2 cases of CWU group shrank to attic but without sac formationed.4) Hearing performance post-operative:Compared topre-operative, mean post-operative AC-PTA achieved 23.720±8.862dB in CWU group, while 20.150±8.140dB in CWD group, audiological assessment in both groups were improved. Focus on patients of chronic suppurative otitis media, the air-bone gap in CWU (19.882±5.337dB) was statistically significantly improved than that in CWD (14.556±6.051dB),P<0.01.5) Complications after surgery:No facial nerve damage, labyrinthitis, any other intracranial and extracranial complications was occurred in both groups. Hydrops in the mastoid cavity was observed in one ear. Another case suffered from tinnitus constantly after operation.Conclusion:Both CWU and CWD had its own advantages, however CWU got a much satisfactory hearing improvement than CWD. According to temporal bone thinner CT scan, pure tone audiometry and eustachian tube function test, also to microscopic examination if conditions permitted, the operation regime should base on low middle cranial fossa or not, far-advanced sigmoid sinus or not, mastoid cavity typing, and the degree of external auditory canal, but the final choice still lies on intraoperative conditions. |
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