Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-28T06:14:09.681Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term status of middle-ear aeration post canal wall down mastoidectomy

Published online by Cambridge University Press:  03 July 2019

T Ezulia ,
B S Goh  and
L Saim
T Ezulia*
Affiliation:
Otorhinolaryngology, Head and Neck Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
B S Goh
Affiliation:
Otorhinolaryngology, Head and Neck Surgery, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
L Saim
Affiliation:
Otorhinolaryngology, Head and Neck Surgery, KPJ Tawakkal Specialist Hospital, Kuala Lumpur, Malaysia
*
Author for correspondence: Dr Tengku Ezulia Binti Tengku Nun Ahmad, Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia E-mail: tengkuezulia@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.

Objective

This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.

Methods

All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.

Results

Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.

Conclusion

After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

Keywords

CholesteatomaMiddle Ear VentilationMastoidectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 8 , August 2019 , pp. 662 - 667
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr T Ezulia takes responsibility for the integrity of the content of the paper

References

1Dornelles, C, Costa, SS, Meurer, L, Schweiger, C. Some considerations about acquired adult and pediatric cholesteatomas. Braz J Otorhinolaryngol 2005;71:536–45Google Scholar
2Alves, DL, Pereira, SB, Ribeiro, FAQ, Fregnan, JHT. Analysis of histopathological aspects in acquired middle ear cholesteatoma. Braz J Otorhinolaryngol 2008;74:835–41Google Scholar
3Park, KH, Park, SN, Chang, KH, Jung, MK, Yeo, SW. Congenital middle ear cholesteatoma in children: retrospective review of 35 cases. J Korean Med Sci 2009;24:126–31Google Scholar
4Janardhan, N, Nara, J, Peram, I, Palukuri, S, Chinta, A, Satna, K. Congenital cholesteatoma of temporal bone with Bezold's abscess: case report. Indian J Otolaryngol Head Neck Surg 2012;64:97–9Google Scholar
5Kemppainen, HO, Puhakka, HJ, Laippala, PJ, Sipilä, MM, Manninen, MP, Karma, PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol 1999;119:568–72Google Scholar
6Drahy, A, De Barros, A, Lerosey, Y, Choussy, O, Dehesdin, D, Marie, JP. Acquired cholesteatoma in children: strategies and medium-term results. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:225–9Google Scholar
7Tabook, SM, Abdel Tawab, HM, Gopal, NK. Congenital cholesteatoma localized to the mastoid cavity and presenting as a mastoid abscess. Case Rep Otolaryngol 2015;2015:305494Google Scholar
8Morimitsu, T. Pathogenesis of cholesteatoma. In: Cholesteatoma and Anterior Tympanotomy. Tokyo: Springer, 1997;95–110Google Scholar
9Michaels, L. Origin of congenital cholesteatoma from a normally occurring epidermoid rest in the developing middle ear. Int J Pediatr Otorhinolaryngol 1988;15:51–65Google Scholar
10Schuknecht, HF. The Pathology of the Ear. Cambridge, MA: Harvard University Press, 1974Google Scholar
11Michaels, L. Biology of cholesteatoma. Otolaryngol Clin North Am 1989;22:869–81Google Scholar
12Spilsbury, K, Miller, I, Semmens, JB, Lannigan, FJ. Factors associated with developing cholesteatoma: a study of 45,980 children with middle ear disease. Laryngoscope 2010;120:625–30Google Scholar
13Chang, CC, Chen, MK. Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma. J Otolaryngol 2000;29:270–3Google Scholar
14Kos, MI, Castrillon, R, Montandon, P, Guyot, JP. Anatomic and functional long-term results of canal wall-down mastoidectomy. Ann Otol Rhinol Laryngol 2004;113:872–6Google Scholar
15Cody, DTR, McDonald, TJ. Mastoidectomy for acquired cholesteatoma: follow-up to 20 years. Laryngoscope 1984;94:1027–30Google Scholar
16Quaranta, A, Cassano, P, Carbonara, G. Cholesteatoma surgery: open vs closed tympanoplasty. Am J Otol 1988;9:229–31Google Scholar
17Hirsch, BE, Kamerer, DB, Doshi, S. Single-stage management of cholesteatoma. Otolaryngol Head Neck Surg 1992;106:351–4Google Scholar
18de Zinis, LO, Tonni, D, Barezzani, MG. Single-stage canal wall-down tympanoplasty: long-term results and prognostic factors. Ann Otol Rhinol Laryngol 2010;119:304–12Google Scholar
19Belcadhi, M, Chahed, H, Mani, R, Bouzouita, K. Predictive factors of recurrence in pediatric cholesteatoma surgery. Mediterr J Otol 2008;4:118–24Google Scholar
20Bujia, J, Sudhoff, H, Holly, A, Hildmann, H, Kastenbauer, E. Immunohistochemical detection of proliferating cell nuclear antigen in middle ear cholesteatoma. Eur Arch Otorhinolaryngol 1996;253:21–4Google Scholar
21Huang, CC, Yi, ZX, Chao, WY. Effect of granulation tissue conditioned medium on the in vitro differentiation of keratinocytes. Arch Otorhinolaryngol 1988;245:325–9Google Scholar
22Proops, DW, Hawak, WM, Parkinson, EK. Tissue culture of migratory skin of the external ear and cholesteatoma: a new research tool. J Otolaryngol 1984;13:63–9Google Scholar
23Jove, MA, Vassalli, L, Raslan, W, Applebaum, EL. The effect of isotretinoin on propylene glycol-induced cholesteatoma in chinchilla middle ears. Am J Otolaryngol 1990;11:5–9Google Scholar
24Huang, T, Yan, SD, Huang, CC. Colony-stimulating factor in middle ear cholesteatoma. Am J Otolaryngol 1989;10:393–8Google Scholar
25Weiss, RA, Eichner, R, Sun, TT. Monoclonal antibody analysis of keratin expression in epidermal diseases: a 48- and 56-kdalton keratin as molecular markers for hyperproliferative keratinocytes. J Cell Biol 1984;98:1397–406Google Scholar
26Kojima, H, Shiwa, M, Kamide, Y, Moriyama, H. Expressive and localization of mRNA for epidermal growth factor and epidermal growth factor receptor in human cholesteatoma. Acta Otolaryngol 1994;114:423–9Google Scholar
27Li, H, Jiang, P, Wang, L. Immunohistochemical study of the epithelial hyperproliferation in middle ear cholesteatoma [in Chinese]. Zhonghua Er Bi Yan Hou Ke Za Zhi 2002;37:118–20Google Scholar
28Barbara, M, Raffa, S, Murè, C, Manni, V, Ronchetti, F, Monini, S et al. Keratinocyte growth factor receptor (KGF-R) in cholesteatoma tissue. Acta Otolaryngol 2008;128:360–4Google Scholar
29Kojima, H, Matsuhisa, A, Shiwa, M, Kamide, Y, Nakamura, M, Ohno, T et al. Expression of messenger RNA for keratinocyte growth factor in human cholesteatoma. Arch Otolaryngol Head Neck Surg 1996;122:157–60Google Scholar
30Yammamoto-Fukuda, T, Aoki, D, Hishikawa, Y, Kobayashi, T, Takahashi, H, Koji, T. Possible involvement of keratinocyte growth factor and its receptor in enhanced epithelial-cell proliferation and acquired recurrence of middle-ear cholesteatoma. Lab Invest 2003;83:123–36Google Scholar
31Vartiainen, E. Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma. Auris Nasus Larynx 2000;27:227–9Google Scholar
32Meuser, W. The exenterated mastoid: a problem of ear surgery. Am J Otol 1985;6:323–5Google Scholar
33Hulka, GF, McElveen, JT Jr. A randomized, blinded study of canal wall up versus canal wall down mastoidectomy determining the differences in viewing middle ear anatomy and pathology. Am J Otol 1998;19:574–8Google Scholar
34Gantz, BJ, Wilkinson, EP, Hansen, MR. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734–40Google Scholar
35Abramson, M, Huang, CC. Localization of collagenase in human middle ear cholesteatoma. Laryngoscope 1977;87(5 Pt 1):771–91Google Scholar
36Haginomori, S, Takamaki, A, Nonaka, R, Mineharu, A, Kanazawa, A, Takenaka, H. Postoperative aeration in the middle ear and hearing outcome after canal wall down tympanoplasty with soft-wall reconstruction for cholesteatoma. Otol Neurol 2009;30:478–83Google Scholar
37Azevedo, AF, Soares, ABC, Garchet, HQC, Sousa, NJ. Tympanomastoidectomy: comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media. Int Arch Otorhinolaryngol 2013;17:242–5Google Scholar
38Segalla, DK, Nakao, LH, Anjos, MF, Penido, NO. Surgical and audiological results after mastoidectomy in a medical residency service [in Spanish]. Acta Otorrinolaringol 2008;26:178–81Google Scholar
39Vartianinen, E, Nuutinen, J. Long-term hearing results of one-stage tympanoplasty for chronic otitis media. Eur Arch Otorhinolaryngol 1992;249:329–31Google Scholar
40Harkness, P, Brown, P, Fowler, S, Grant, H, Ryan, R, Topham, J. Mastoidectomy audit: results of the Royal College of Surgeons of England comparative audit of ENT surgery. Clin Otolaryngol Allied Sci 1995;20:89–94Google Scholar
41Sade, J. The atelectatic ear. In: Sade, J, ed. Monograms in Clinical Otolaryngology, Secretort Otitis Media and its Sequelae. New York: Churchill-Livingstone, 1979;64–88Google Scholar
42Tos, M, Poulsen, G. Attic retractions following secretory otitis. Acta Otolaryngol 1980;89:479–86Google Scholar
43Ikeda, M, Yoshida, S, Ikui, A, Shigihara, S. Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity. J Laryngol Otol 2003;117:249–55Google Scholar