Handzel, Ophir1,2
1 Depratment of Otolaryngology/Head, Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Israel;
2 Sackler Faculty of Medicince, Tel-Aviv University, Israel.
Introduction:
To achieve the goals of surgery for chronic otitis media the traditional choice between canal wall up (CWU) and down mastoidectomy (CWD) factored the improved quality of life of the former with better long term control of disease in the latter. Endoscopic ear surgery (EES) can provide the disease extirpating capabilities of the “open cavity” and bone obliteration of the mastoid and attic (called BOT by some) may similarly reduce chances of recurrent disease, while providing the functional benefits of the canal wall up procedure.
Methods:
Case series of patients undergoing primary or revision surgery for cholesteatoma involving the mastoid, with disease suitable for CWD procedures but treated instead with CWU mastoidectomy utilizing ESS and BOT. Five patients met the inclusion criteria. One (5 year old) had an extensive congenital cholesteatoma and four had an acquired disease. The mastoid and attic were obliterated with wither bone pate (n=3) or BonAlive (n=2). The attic was segregated from the middle ear by a combination of fascia and cartilage.
Results:
Follow up was 6-12 months. All middle ears were aerated and none had recurrent disease. Water precautions was necessary in none. Early hearing results are relevant to four of the patients: air-bone gap range was 10-35dB.
Conclusion:
Short term results are encouraging. For some of patients with cholesteatoma warranting a CWD tympanomastoidectomy, a CWU procedure with ESS and bone obliteration of the mastoid and attic can achieve the goals of chronic ear surgery with superior quality of life.