Ceravital reconstruction of canal wall down mastoidectomy

Objective: To describe long-term outcomes of external auditory canal wall reconstruction using bioactive glass ceramic (Ceravital) after canal wall down mastoidectomy. Design: Retrospective review of a case series over a 21-year period, with a mean +/- SD follow-up of 13.1 +/- 6.7 years (range, 0.2-20.5 years). Setting: Private otologic practice. Patients: The study population comprised 20 consecutive patients aged 12 to 60 years, who had previously undergone canal wall down mastoidectomy. Intervention: Reconstruction of the canal wall with bioactive glass ceramic. Main Outcome Measures: Incidence, cause, and timing of reconstruction failure; need for additional surgery; change in hearing; frequency of outpatient visits; and incidence of surgical complications. Results: Prosthetic walls have remained intact in 16 patients followed for more than 5 years. One had remained intact at 3 months after surgery, but the patient was lost to follow-up. Prosthesis removal was required in 3 patients (because of infection, displacement, and cholesteatoma in 1 patient each). The only perioperative complications were otorrhea in 4 patients and a 5-dB sensorineural hearing loss in 1 patient. Of the 16 intact patients with long-term follow-up, 4 required no further surgery, while 11 underwent an average of 2 subsequent middle ear procedures each (range, 1-3), including 4 planned reexplorations. The mean SD air bone gap improved 11 +/- 16 dB as of the most recent audiogram (mean +/- SD, 7.7 +/- 5.8 years after operation). Conclusion: Canal wall reconstruction using bioactive glass ceramic is a useful option for patients who desire freedom from the frequent mastoid bowl debridements and activity restrictions that may result from canal wall down mastoidectomy.