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01-04-2013 | Surgery | Article

Retrograde mastoidectomy effective in cholsteatoma patients

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medwireNews: The retrograde mastoidectomy technique for cholesteatoma removal appears to be a well-tolerated and effective procedure, report researchers.

The technique resulted in a satisfying level of hearing being achieved for the majority of patients along with an acceptable recurrence rate of 12.7% in a study of 218 individuals.

The retrograde mastoidectomy is intended to combine the advantages of the two main approaches currently used for cholesteatoma removal - the canal wall up and canal wall down techniques, explain Amir Minovi (Ruhr-University, Bocham, Germany) and colleagues.

"With this technique, the posterior bony canal wall is removed partially or entirely for cholesteatoma extirpation. Depending on the size of the defect, the canal wall is reconstructed using bone, cartilage, or alloplastic materials within one procedure," they say. The technique is designed to allow for significantly improved visibility of the epitympanic space and supratubal recess during dissection, as well as allowing simultaneous reconstruction of the posterior canal wall.

The researchers conducted a retrospective chart review of 218 adults (aged a mean of 48.2 years) who underwent retrograde mastoidectomy between January 2006 and June 2011. Overall, 242 operated ears were represented with an average follow-up time of 20.3 months.

As reported in European Archives of Otolaryngology, the posterior canal wall was reconstructed in 151 (62.4%) cases, while an open cavity was formed in 91 (37.6%). In the majority (213; 88%) of cases, primary hearing restoration was performed, while a second-look surgery was indicated in 54 (22.3%) cases.

Overall, cholesteatoma recurred in 40 (16.5%) cases, 18 (12.7%) of which occurred in primary operations and 22 (22%) in revision surgeries.

The team reports that before surgery, 66.9% of the operated ears had a pure-tone average air-bone gap (PTA-ABG) of more than 20 dB and only 6.2% had a PTA-ABG of 10 dB or below. However, after retrograde mastoidectomy, an excellent or good hearing result (PTA-ABG of 0-20 dB) was achieved in 61.6% of the operated ears.

Patients who had a primary surgery had significantly better PTA-ABG than those who underwent revision surgery, with an excellent hearing result (≤10 dB) achieved in 35.9% of the primary surgeries compared with in only 10% of revision surgeries.

The researchers say the retrograde mastoidectomy technique provides the surgeon with "an adequate intraoperative visualization and the patient with an optimal postoperative hearing and quality of life outcome."

By Sally Robertson, medwireNews Reporter

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