Author(s)
Aaron M. Domack, MD
Ralph Lamonge
John P. Leonetti, MD
Affiliation(s)
Loyola University Medical Center;
Abstract:
Introduction: Canal wall down (CWD) mastoidectomy is primarily reserved for refractory chronic ear disease. Recurrent cholesteatoma, narrow external auditory meatus, high facial ridge, and residual diseased air cells are the most common findings in revision CWD mastoidectomy cases in the literature. This study aims to share a single surgeon’s experience of revision CWD mastoidectomy to identify failures of primary CWD surgery and postulate keys for long-term success.
Methods: A retrospective review was conducted for 53 adult patients who underwent revision CWD mastoidectomy by the senior author at a tertiary academic medical center from 2007 to 2019. We reviewed and collected data from the patient's preoperative, surgical, and postoperative course. Descriptive statistics were performed with additional statistical analysis in progress.
Results: Otorrhea (72.2%) and new hearing loss (27.8%) were the most common presenting symptoms while recurrent cholesteatoma (51.9%) and granulation tissue (50%) were the most common findings on the patient’s preoperative physical exam. Findings at surgery were recurrent cholesteatoma (83%), narrow meatus (49%), and high facial ridge (35.8%). Forty-seven patients (87%) achieved a dry ear at an average of 9 months.
Conclusions: The surgical approach for chronic ear disease should emphasize a wide meatoplasty and complete lowering of the facial ridge to obtain an adequate canal wall down mastoid and avoid revision surgery.