INTACT CANAL WALL TYMPANOMASTOIDECTOMY FOR CHOLESTEATOMA: TECHNICAL TIPS, TRAPS, PITFALLS AND RESULTS

David A. Moffat

Consultant in Otoneurological and Skull Base Surgery, Addenbrooke’s, Cambridge University Hospital, Hills Road, Cambridge, UK

Introduction

This instructional course is based on the author’s cumulative experience of intact canal wall tympanomas-toidectomy in adults and children over a thirty year period.

Method

A critical analysis of the outcome of surgery has enabled an evolution of technique by attempting several different methods of achieving the same end result. An exposition of each stage of this procedure has been possible with a personal opinion of the most satisfactory way of achieving a good surgical outcome. Technical tips for achieving this are discussed in the form of an ‘How I do it’ presentation. This will include the traps and pitfalls for the unwary embarking on this type of surgery. Reconstructive materials in outer attic wall repair and the effect on the outcome of the use of the oto-endoscope and KTP laser will be revealed and discussed in relation to the evolution of technique over time.

Results

The long-term results of this surgery are presented in 245 patients and an analysis of 543 operations. The residual cholesteatoma rate at the second stage was 11% in the adult group and 28% in the children’s group. A third-stage operation was required in 13% of the adults and 25% of the children. The recurrent cholesteatoma rate was 2.3% in adults and 6.6% in children.

Discussion

This study has demonstrated a relatively low residual cholesteatoma rate in adults but a higher rate in children and the recurrent cholesteatoma rate which was low in adults was also higher in children. These results compare favorably with other studies and reflect the difficulties in managing cholesteatoma in children. A personal view of how best to improve the outcome in intact canal wall tympanomastoidectomy has resulted from this study.


Address for correspondence: David Moffat BSc, MA, PhD, FRCS, Department of Neuro-otology and Skull Base Surgery, Box 48, Addenbrooke’s, Cambridge University Hospital, Hills Road, Cambridge, CB0 2QQ, UK. dam26@cam.ac.uk

Cholesteatoma and Ear Surgery – An Update, p. 173

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands