Second Stage Reconstruction After Canal Wall Down Mastoidectomy

Introduction Primary goal in surgical management of chronic otitis media with cholesteatoma is the creation of a dry, safe ear through removal of disease and prevention of recurrence. Canal wall up (CWU) techniques preserve the anatomy of the posterior canal wall, eliminating the need for periodic bowl cleaning and avoiding the risk of recurrent bowl infections. However, the recurrence rate may be as high as 36% in adults and 67% in children after CWU procedures. Canal wall down (CWD) mastoidectomy is also used for management of cholesteatoma . Complete posterior canal wall removal provides exposure of the entire attic, especially the region of the anterior zygomatic cell tract. Removal of the posterior canal wall enhances exposure of the entire epitympanum and middle ear, helping to ensure complete disease eradication. This approach may reduce the recurrance rate to as low as 2%.