Download PDF
Int Arch Otorhinolaryngol 2013; 17(03): 242-245
DOI: 10.7162/S1809-97772013000300002
Original Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media

Alexandre Fernandes de Azevedo
1   MD in Infectology at the Federal University of Minas Gerais. Assistant Doctor - Otolaryngology Clinic of Santa Casa B.H.
,
Anna Bárbara de Castro Soares
2   Resident of Plastic Surgery at the Hospital Mater Dei.
,
Henrique Queiroz Correa Garchet
3   Resident of Otolaryingology at the Santa Casa B.H.
,
Nicodemos José Alves de Sousa
4   M.D. in Otolaryngology at the Federal University of São Paulo. Honorary Chief of the Otolaryngology Clinic of Santa Casa B.H.
› Author Affiliations
Further Information

Publication History

02 September 2012

15 April 2013

Publication Date:
21 January 2014 (online)

Also available at
   Permissions and Reprints

Summary

Introduction: Chronic otitis media (COM) is an inflammatory condition associated with otorrhea as well as large and persistent perforations of the tympanic membrane in some cases. COM can also lead to cholesteatoma. Surgical treatment with canal wall-down and canal wall-up tympanomastoidectomy is considered for both types of illness. The choice of technique is controversial and is dependent on several factors, including the extent of disease.

Objective: We aimed to evaluate surgical outcomes in COM patients with and without cholesteatoma treated with canal wall-down and canal wall-up tympanomastoidectomy. Disease eradication and post-operative auditory thresholds were assessed.

Method: Patient records from the otorhinolaryngology department of a tertiary hospital were assessed retrospectively.

Results: Patients who underwent canal wall-up tympanomastoidectomy had a higher rate of revision surgery, especially those with cholesteatoma. However, there were no statistically significant differences in post-operative hearing thresholds between the two techniques.

Conclusion: The canal wall-down technique is superior to the canal wall-up technique, especially for patients with cholesteatoma.

Keywords

Chronic Disease - Otitis Media - Hearing Loss - Cholesteatoma - Middle Ear - Reoperation
 

  • References

  • 1 Costa SS, Dornelles CC, Netto LFS, Braga MEL. Aspectos gerais das otites médias. In: Costa SS, Cruz OLM, Oliveira JAA. Otorrinolaringologia Princípios e Prática. 2nd ed. São Paulo: Artmed; 2006. p. 254–73
    Google Scholar
  • 2 Bluestone CD. Epidemiology and pathogenesis of chronicsuppurative otitismedia: implications for prevention and treatment. Int J Pediatr Otorhinolaryngol 1998; Jan; 420: 207-23
    Google Scholar
  • 3 Azevedo AF, Pinto DCG, Souza NJA, Greco DB, Gonçalves DU. Perda auditiva sensório-neural na otite média crônica supurativa em pacientes com e sem colesteatoma. Braz J Otorhinolaryngol 2007; Sep-Oct; 73 (5) 671-4
    Google Scholar
  • 4 Godinho RN, Goncalves TM, Nunes FB , et al. Prevalence and impact of chronicotitismedia in school age children in Brazil. First epidemiologic study concerning chronicotitismedia in Latin America. Int J Pediatr Otorhinolaryngol 2001; Dec; 61 (3) 223-32
    CrossrefGoogle Scholar
  • 5 Cruz OLM, Campos CAH. Cirurgia para a otite média crônica. Acta Otorrinolaringol 2005; 23 ((1):) 33-8
    Google Scholar
  • 6 Roland PS, Isaacson B, Kutz JW. Office management of tympanic membrane perforation and the draining ear. In: Brackmann DE, Shelton C, Arriaga MA. Otologic Surgery. 3rd ed. Philadelphia: Saunders Elsevier; 2010. p. 107–18
    Google Scholar
  • 7 Segalla DK, Nakao LH, Anjos MF, Penido NO. Resultados cirúrgicos e audiológicos pós mastoidectomia em um serviço de Residência Médica. Acta Otorrinolaringol 2008; 26 (3) 178-81
    Google Scholar
  • 8 Vartianinen E, Nuutinen J. Long term hearing results of one stage tympanoplasty for chronic otitis media. Eur Arch Otorhinolaryngol 1992; 249 (6) 329-31
    Google Scholar
  • 9 Veldman JE, Braunius WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with a long-term follow-up. Ann Otol Rhinol Laryngol 1998; Jun; 107 (6) 486-91
    Google Scholar
  • 10 Cruz OL, Kasse CA, Leonhart FD. Efficacy of surgical treatment of chronic otitis media. Otolaryngol Head Neck Surg 2003; Feb; 128 (2) 263-6
    CrossrefGoogle Scholar
  • 11 Cruz OLM, Kasse CA, Leonhardt FD. Eficácia do tratamento cirurgico da otite média crônica colesteatomatosa. Braz J Otorhinolaryngol 2001; Mar-Apr; 67 (2) 142-6
    Google Scholar
  • 12 Cook JA, Krishnan S, Fagan PA. Hearing results following modified radical versus canalup mastoidectomy. Ann Otol Rhinol Laryngol 1996; May; 105 (5) 379-83
    Google Scholar
  • 13 Chang CC, Chen MK. Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma. J Otolaryngol 2000; Oct; 29 (5) 270-3
    Google Scholar
  • 14 Bento RF, Rezende VA, Soares IP. Mastoidectomia: Estado atual da indicação cirúrgica do ponto de vista infeccioso. Braz J of Otorhinolaryngol 2004; Apr-Jun; 60 (2) 98-102
    Google Scholar
  • 15 Harkness 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; Feb; 20 (1) 89-94
    Google Scholar
  • 16 Zhang X, Chen Y, Liu Q, Han Z, Xu A, Ding Y. Long-term results analysis of mastoidectomy for chronic otitis media. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2005; Oct; 19 (19) 870-2
    Google Scholar
  • 17 Murphy TP, Wallis DL. Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery. Otolaryngol Head Neck Surg 1998; Nov; 119 (5) 439-43
    CrossrefGoogle Scholar