Retrograde mastoidectomy with reconstruction: A follow-up canal wall report

Objective: To evaluate long-term results of retrograde mastoidectomy with canal wall reconstruction as a single-stage technique for cholesteatoma removal. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Forty-six patients, representing 50 ears (20 pediatric and 30 adult), who had undergone surgery for cholesteatoma removal with said technique and had an average follow-up of 7.8 years. Interventions: Temporary removal of the upper canal wall, in association with a retrograde-type mastoidectomy, for full exposure and extirpation of the disease, followed by reconstruction of the canal defect using cymba cartilage. Main Outcome Measures: Preoperative and short- and long-term postoperative audiogram, obtained as four-frequency pure-tone average air-bone gap. Complications, including presence of recurrent or residual cholesteatoma, need for tube insertion, perforation, and poor hearing requiring revision surgery, were also reported and correlated with the patient's tobacco use. Results: The average preoperative, short-term postoperative, and long-term postoperative pure-tone average air-bone gap was 25.6 +/- 11.2 dB, 11.0 +/- 5.7 dB, and 12.4 +/- 6.4 dB, respectively. There were significant differences between the pre- and postoperative values (p < 0.5), but there was no significant difference between short- and long-term hearing results. Recurrent cholesteatomas were seen in eight ears (16%); pressure-equalizing tube insertion was performed postoperatively in nine ears (18%); a perforation was seen in one ear (2%); and two ears (4%) had poor hearing results requiring second-look surgery. The long-term complication rate of smokers was 79% (15 of 19), compared with 16% (5 of 31) for nonsmokers. Conclusion: This single-stage technique for cholesteatoma removal and canal wall reconstruction showed acceptable long-term results, but tobacco use was associated with a higher long-term complication rate.