Bone Pate Obliteration in Canal Wall Down Mastoidectomy: Modifications of an Established Technique

Objective: To describe outcomes with obliteration of the mastoid and medial attic following canal wall down mastoidectomy for cholesteatoma. Our technique uses bone pate in the mastoid and cartilage in the epitympanum and supratubal recess. Study Design: Retrospective observational study. Setting: Tertiary medical center. Patients: Ten years of sequential canal wall down mastoidectomies with obliteration from one neurotologist were reviewed. This included primary and revision cases in adults and children. Main Outcome Measures: Complications, location and extent of cholesteatoma, the presence of a dry ear after surgery, cholesteatoma recidivism, revision procedures, and postoperative hearing. Results: Seventy-eight patients (79 ears) met inclusion criteria. There were few major complications. There was active follow-up of a year or more in 61. For these, the mean follow-up was 3.1 years, and approximately 90% had a dry cavity for the remainder of their follow-up. About half required minimal (if any) maintenance. There were five cases with residual disease, and no cases with recurrent disease. There were five cases that were considered failures, with three taking several years to manifest. There were no cases where cholesteatoma was buried in bone pate. A sizeable minority continued to have active tubotympanic disease despite successful treatment of the attic and mastoid. Conclusions: This seems to be a safe and reliable means to eradicate cholesteatoma and create a dry, low-maintenance cavity. It is not a cure for tubotympanic disease, and a small minority of initially stable cavities may fail several years following surgery. Level of Evidence: 4.