Mastoid Cavity Obliteration with Combined Palva Flap and Bone pâté

Introduction: This study was designed to evaluate the usefulness of mastoid cavity obliteration with combined bone pâté and Palva flap in the prevention of problematic mastoid cavities after canal wall down mastoidectomy.   Materials and Methods: In a prospective longitudinal study with a mean follow-up of 28 months conducted between 2008–2012, a series of 56 ears in 48 patients with chronic otitis media due to a cholesteatoma underwent canal wall down mastoidectomy that their mastoid cavity obliterated with combined bone pâté and Palva flap. Seventeen (30%) ears were managed via revision surgery, with the reminder via primary surgery. Data included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications.   Results: All patients underwent second-look surgery. Forty-six (82%) ears maintained a very small, dry and healthy mastoid cavity. Seven (13%) ears had occasional otorrhea, and three (5%) ears had small granulation tissue. Seven (12.5%) ears had residual cholesteatoma pearl in the middle ear at second-look surgery. Four (7%) ears exhibited wound infection.   Conclusion:  Canal wall down mastoidectomy and mastoid cavity obliteration with combined bone pâté and Palva flap is a effective option for the complete removal of cholesteatoma and prevention of postoperative mastoid cavity problems.