Ear canal wall up mastoid surgery-various aspects-
The objective of cholesteatoma treatment is to eliminate the disease and establish a secure and dry ear while preventing the reappearance of the condition and preserving or potentially enhancing hearing (1). The optimal surgical technique for cholesteatoma treatment has been a topic of debate for many years. Although both canal wall down (CWD) and canal wall up (CWU) tympanomastoidectomy possess their pros and cons, the CWU method is frequently favored as it avoids the creation of a radical cavity. A radical cavity may lead to a situation with higher frequencies of recurrent otitis and necessitates consistent debridement. In contrast, the CWU method preserves the typical anatomy of the external ear canal, generally resulting in fewer instances of refractory otitis. Furthermore, after CWU surgery, routine debridement of the ear is typically not necessary, and hearing aids are better suited and more comfortably tolerated (2–4). However, a major concern linked to choosing the CWU method is the heightened risk of recurrent and residual cholesteatoma (5). In previous studies, recidivism rates—including both recurrent and residual rates—have been documented as 4 to 17% when employing CWD tympanomastoidectomy, compared to rates ranging from 9% to 70% with the CWU method (5, 6). Since the wide variation in prevalence cannot solely be attributed to the surgical method, various other factors must play a role, including the surgeon’s experience and patient-related considerations.
There has been increasing interest in filling the epitympanic and mastoid regions following either CWD or CWU tympanomastoidectomy, with the main aim of enhancing disease control. The initial efforts were recorded in 1911 by Mosher (7). Mercke was among the first otologists to report results with low recurrent and residual rates following obliteration in conjunction with CWD tympanomastoidectomy (8). Encouraging results as detailed by Offeciers et al. ensued using a different technique, which maintained the posterior canal wall (9). Recently, van der Toom et al. demonstrated in their systematic review that obliterating the mastoid decreases the recurrence rates for both the CWD (5. 9% recurrent rate, 5. 8% residual rate) and CWU techniques (0. 28% recurrent rate, 4. 2% residual rate) (6). Therefore, merging the CWU technique with obliteration appears to be a promising strategy to enhance disease control.
