Partial Mastoid Obliteration Combined With Soft-wall Reconstruction for Middle Ear Cholesteatoma

Abstract

Objectives: The objective was to analyze the surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma. Methods: Sixty-nine patients (73 ears) with fresh middle ear cholesteatomas, 42 men and 27 women aged 6 to 89 years, were retrospectively analyzed. The cholesteatomas were the pars flaccida and tensa types in 59 and 12 ears, respectively. The patients underwent canal-wall-down tympanoplasty with partial mastoid obliteration and soft-wall reconstruction. Follow-up computed tomography was performed 6 to 12 months after surgery. Hearing outcomes were evaluated by the arithmetic mean of the hearing levels at 500, 1000, and 2000 Hz. Results: Residual cholesteatoma occurred in 7 ears (9.6%) and recurrent cholesteatoma in 1 ear (1.4%). No cavity problem was seen. Primary evaluation of postoperative hearing was performed 6 to 12 months after ossiculoplasy. Of the 50 ears with available audiogram in this period, the postoperative air-bone gaps were ≤15 dB and ≤20 dB in 27 (54.0%) and 37 (74.0%) ears, respectively. The postoperative hearing level was within 30 dB in 22 ears (44.0%). The hearing gain was ≥15 dB in 24 ears (48.0%). Conclusions: The surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma were satisfactory with a low incidence of cholesteatoma recidivism and tolerable postoperative hearing without cavity problems.