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  • Title: Long-term results of canal wall reconstruction tympanomastoidectomy.
    Author: Walker PC, Mowry SE, Hansen MR, Gantz BJ.
    Journal: Otol Neurotol; 2014 Jul; 35(6):954-60. PubMed ID: 25072070.
    Abstract:
    OBJECTIVES: This study was designed to evaluate the long-term results using the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma. STUDY DESIGN: Institutional review board-approved retrospective case review. SETTING: Tertiary referral center. PATIENTS: Retrospective review was performed on consecutive patients undergoing CWR tympanomastoidectomy with mastoid obliteration at a single institution from 1997 to 2011. MAIN OUTCOME MEASURES: Status of tympanic membrane and ear canal anatomy, preoperative and postoperative audiometry,residual cholesteatoma at second look surgery, postoperative complications, recurrence rate, and location. RESULTS: Two hundred eighty-five ears in 273 patients underwent CWR tympanomastoidectomy with a mean age of 35 years with average follow-up of 4.29 years (median, 3.16 yr).A second-look ossiculoplasty was performed in 253 (89%). Recurrent retraction pocket formation occurred in 34 ears (13%). A secondary endaural atticotomy only was required to improve access for debridement in 16 of these 34 ears (5.8% of total ears).Only 7 ears (2.6%) required a revision open cavity mastoidectomy(n = 5) or subtotal petrosectomy (n = 2) for recurrent cholesteatoma. Those undergoing second-look ossiculoplasty demonstrated a small improvement in preoperative versus postoperative air-bone gap (ABG), 28 dB versus 23 dB, respectively.Postoperative infection occurred in 16 patients(5.6%) with 1 patient requiring conversion to open cavity mastoidectomy. CONCLUSION: A CWR tympanomastoidectomy provides excellent intraoperative exposure of the middle ear and mastoid without the long-term disadvantages of a canal wall down mastoidectomy. Long-term follow-up demonstrates that there were only 2.6% failures requiring conversion to an open cavity or subtotal petrosectomy.
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