Canal Wall down Mastoidectomy and Tympanoplasty in Cholesteatoma Surgery: Ten Years’ Experience

Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate the disease and maintain a safe and dry ear. This retrospective study was designed to evaluate the functional results of cholesteatoma patients who underwent canal wall down mastoidectomy in conjunction with a tympanoplasty. Operated ears due to chronic otitis media with cholesteatoma were considered for the study. The study was carried out in 120 ears. The choice of technique for tympanoplasty is based on the pathology encountered in the stapes superstructure. Patients were divided into three: 1) Group A, a type II TPL with stapes columella reconstruction; 2) Group B, a type III TPL with major columella reconstruction; and 3) Group C, a type IV TPL using a temporalis fascia and thick cartilage to shield the round window. The operated ears of Groups A and B, as compared to Group C, presented a significant decrease in the pre-operative Air-bone gap and an increase in the number of operated ears with an Air-bone gap between 0 20 dB. The study emphasizes the importance of functional separation of the two acoustic windows by fascia and cartilage graft when the stapes superstructure is missing but the footplate is mobile.