Ceravital reconstruction of canal wall down mastoidectomy: long-term results.

OBJECTIVE To describe long-term outcomes of external auditory canal wall reconstruction using bioactive glass ceramic (Ceravital) after canal wall down mastoidectomy. DESIGN Retrospective review of a case series over a 21-year period, with a mean +/- SD follow-up of 13.1 +/- 6.7 years (range, 0.2-20.5 years). SETTING Private otologic practice. PATIENTS The study population comprised 20 consecutive patients aged 12 to 60 years, who had previously undergone canal wall down mastoidectomy. INTERVENTION Reconstruction of the canal wall with bioactive glass ceramic. MAIN OUTCOME MEASURES Incidence, cause, and timing of reconstruction failure; need for additional surgery; change in hearing; frequency of outpatient visits; and incidence of surgical complications. RESULTS Prosthetic walls have remained intact in 16 patients followed for more than 5 years. One had remained intact at 3 months after surgery, but the patient was lost to follow-up. Prosthesis removal was required in 3 patients (because of infection, displacement, and cholesteatoma in 1 patient each). The only perioperative complications were otorrhea in 4 patients and a 5-dB sensorineural hearing loss in 1 patient. Of the 16 intact patients with long-term follow-up, 4 required no further surgery, while 11 underwent an average of 2 subsequent middle ear procedures each (range, 1-3), including 4 planned reexplorations. The mean +/- SD air bone gap improved 11 +/- 16 dB as of the most recent audiogram (mean +/- SD, 7.7 +/- 5.8 years after operation). CONCLUSION Canal wall reconstruction using bioactive glass ceramic is a useful option for patients who desire freedom from the frequent mastoid bowl debridements and activity restrictions that may result from canal wall down mastoidectomy.