Long-term clinical and radiological results for fat graft obliteration in subtotal petrosectomy and cochlear implant surgery: a retrospective clinical study.

PURPOSE: The study aimed to evaluate the long-term clinical, radiological, and functional results for subtotal petrosectomy and cochlear implant surgery with closure of the external auditory canal and fat obliteration. METHODS: We retrospectively included all consecutive cases of simultaneous subtotal petrosectomy and cochlear implant surgery performed at a tertiary referral center between 2009 and 2016 using the same surgical technique. All patients underwent postoperative high-resolution computed tomography (HRCT) and annual audiological assessments. A 5-year minimum clinical, radiological, and audiological follow-up was performed. The early and late postoperative results were compared. The main outcome measures were complications, postauricular retraction, fat graft reabsorption, and audiological outcomes. RESULTS: Twenty-nine procedures performed in 23 patients (six bilateral) met the inclusion criteria. The mean age of the patients was 67 ± 13.4 years and mean follow-up duration was 7.5 ± 2 years. At follow-up, postauricular retraction was detected in 24 cases (82.8%), including five cases (17.1%) with subcutaneous protrusion of implant and array. Fat graft volume was significantly reduced at late-HRCT in terms of maximum diameter (2.24 ± 1.0 cm vs 3.69 ± 0.7 cm; p < 0.0005) and surface area (1.88 ± 1.2 vs 4.24 ± 1.6 cm2, p < 0.0005). Six patients had extracochlear electrodes at late-HRCT (3/6 had an increased number of extracochlear electrodes), with a lowering of this group's performance of - 15% (p < 0.005) in the follow-up speech comprehension test. CONCLUSIONS: Subtotal petrosectomy with cochlear implantation is an effective long-term technique in selected cases. Fat grafts showed significant reabsorption at long-term follow-up with reaeration of the middle ear spaces. Prolonged clinical and radiological follow-up is recommended for monitoring implant performances and late complications.

External auditory canal reconstruction using a novel mastoidoplasty technique during canal wall down mastoidectomy: how I do it.

BACKGROUND: While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative. METHODS: Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC. CONCLUSIONS: The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.

Mastoid obliteration versus canal wall down or canal wall up mastoidectomy for cholesteatoma: Systematic review and meta-analysis.

BACKGROUND: There is ongoing debate over the optimal surgical approach for cholesteatoma treatment1-5. The aim of this review was to determine whether canal-wall down with mastoid obliteration is associated with favourable outcomes compared to either canal-wall down without obliteration or canal-wall up. The primary outcome was cholesteatoma reoccurrence with secondary outcomes including otorrhoea, reoperation and patient-reported outcome measures. METHODS: Medline, Embase, Cochrane databases and clinicaltrials.gov were searched for studies reporting outcomes of patients undergoing primary CWD-MO for cholesteatoma and directly compared with CWD and CWU mastoidectomies. Data were collated and meta-analysis performed. RESULTS: 2379 patients were included from 12 studies that met the inclusion criteria. CWD-MO was found to be associated with significantly less risk of recurrence when compared to CWU (OR = 0.330 (95 % CI 0.191-0.570, p < 0.001). When compared to CWD, CWD-MO was associate with significantly lower incidence of persistent otorrhoea (OR 0.405 (95 % CI 0.232-0.706, p < 0.001) while the rates of recurrence were comparable (OR: 1.231 [95 % CI: 0.550-2.757] p = 0.613). Otorrhoea rates between CWD-MO and CWU were equivalent as was reoperation. Quality of life and hearing outcomes were variably reported. CONCLUSIONS: This systematic review demonstrates that CWD-MO technique achieves lower recurrence rates comparable to CWD approaches and superior to CWU, while offering improved long-term control of otorrhoea. The final procedural choice should be decided based on surgeon experience, skill set and individual patient factors. To address the risk of selection bias, a randomised controlled trial is needed to answer this important research question.

Mastoid obliteration with hydroxyapatite vs. bone pâté in mastoidectomy surgery performed on patients with cholesteatoma and chronic suppurative otitis media: a retrospective analysis.

PURPOSE: To compare the efficacy and safety of hydroxyapatite vs. bone pâté as obliteration material in mastoidectomy surgery for patients with chronic suppurative otitis media and cholesteatoma. METHODS: This is a retrospective, multi-center, cohort study. All patients were followed up with micro-otoscopy, audiometry, and, if indicated, MRI with diffusion-weighted imaging. The following outcome parameters were analyzed: procedure safety (wound infections and complications), cholesteatoma recidivism rates (residual/recurrent), control of infection (Merchant's scale), and hearing results (pure-tone averages at 500/1000/2000/4000 Hz). RESULTS: Eighty-three cases were included: 45 obliterated with hydroxyapatite and 38 with bone pâté, with a mean follow-up time of, respectively, 25 and 24 months. Wound infections were only detected in the bone pâté group (4.8%) and successfully treated with oral or intravenous antibiotics and surgical drainage (p = 0.026). No other major surgical complications were observed in both groups. Cholesteatoma recidivism was observed in 15% using hydroxyapatite and 12% using bone pâté (p = 0.471). Complete control of infection (Merchant 0) was achieved in 76.2% using bone pâté and 86.8% using hydroxyapatite at 12 months postoperatively (p = 0.223). All patients showed good postoperative healing without complete failure to manage infection (Merchant 3). Pre- and postoperative audiometry showed significant improvement in hearing results in both groups. No significant difference between the obliteration materials was observed. CONCLUSIONS: Evaluation of mastoid obliteration reveals that hydroxyapatite and bone pâté are safe and effective obliteration materials, with high success rates in achieving a dry ear, low recidivism rates, and good hearing outcome, respecting the short-term limitation. In addition, our study shows that hydroxyapatite results in fewer postoperative wound infections compared to bone pâté.

Use of bonalive in obliterative mastoidectomy: anatomical results and clinical outcome.

PURPOSE: To investigate safety and efficacy of mastoid obliteration in canal-wall-down tympanoplasty performed for cholesteatoma using bioactive glass (BAG). The authors routinely adopt CWD tympanoplasty in case of massive cholesteatoma or revision surgery, performing obliteration with BAG to reduce the mastoid cavity and related disadvantages. We assessed anatomical results, infection control and cholesteatoma recurrence in obliterative mastoidectomy using BAG. METHODS: The authors evaluated 66 patients treated with obliterative mastoidectomy using BAG during the period 2010-2021. 48.5% of the cases had first diagnosis of cholesteatoma, 48.5% had cholesteatoma recidivisms, and two patients underwent obliteration to improve clinical outcome. BAG granules were always moistened with venous blood to enhance their adhesion and reduce the risk of dispersion. Anatomical results were evaluated in otomicroscopy and infection control was assessed during follow-up visits. Periodical otomicroscopy was performed to check recurrent cholesteatoma. MRI-DWI was indicated only in case of clinical suspect of cholesteatoma. RESULTS: Authors followed 66 patients during a mean of 23 months. No post-operative wound infections occured. The mean re-epithelialization time was 45 days. At the last visit, control of infection was achieved in 97% of patients and a clinical stable anatomical cavity in all patients. No clinical suspect for recurrent cholesteatoma was found. CONCLUSIONS: The use of bioactive glass is safe and effective as obliteration material in cholesteatoma surgery. Authors pay a particular attention to obliterate only patients without suspect of epithelial residual, to correctly calibrate the ear canal and to completely cover the granules with graft.

Post-operative healing and long-term stability after mastoid cavity reconstruction using the middle temporal artery and inferior musculoperiosteal flaps.

PURPOSE: This study aims to evaluate the surgical outcomes with the use of a combination of the middle temporal artery (MTA) flap and the inferior musculoperiosteal (IMP) flap for mastoid obliteration after canal wall down mastoidectomy. METHODS: Seventy-five patients who have undergone canal wall down mastoidectomy and mastoid obliteration with the MTA and the IMP flaps at a single tertiary hospital were included. Surgical outcomes measured included the creation of a dry mastoid cavity as measured by a previously developed semi-quantitative scale, mastoid cavity epithelization time, rate of revision surgery needed, and rate of recurrent cholesteatoma. RESULTS: Patients were followed up for a median of 29 months. The median time to epithelization of the mastoid cavity was 2 months. At 1 and 3 months, 36.0% and 76.0% of patients had grade 0 and grade 1 cavities, respectively, with either a dry cavity or one or less episodes of mild otorrhea or sensation of wetness. Hundred percent of the patients achieved a grade 2 (more than one episode of otorrhea or the presence of granulation tissue that promptly resolved with simple treatment) or better cavity at 3 months. One patient re-presented with a grade 3 cavity with uncontrolled infection and daily otorrhea secondary to an attic perforation that manifested at 6 months, requiring revision surgery. There were no recurrent cholesteatomas during the follow-up period. CONCLUSIONS: The use of the MTA and the IMP flaps for mastoid obliteration may be considered as an adjunct to achieving a safe, dry ear after canal wall down mastoidectomy.

[Mastoid obliteration during last 5 years]. / Mastoidoplastika: tendentsii poslednikh 5 let.

The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.

Mastoid obliteration with S53P4 bioactive glass after canal wall down mastoidectomy: Preliminary results.

BACKGROUND: Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. PURPOSE: The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. METHODS: 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. RESULTS: There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. CONCLUSION: Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).

Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration.

PURPOSE: The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids. METHODS: The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan. RESULTS: External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group. CONCLUSIONS: Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.

[The results of surgical ablation of parathympanic spaces in the patients presenting with cholesteatoma]. / Rezul'taty khirurgicheskoi obliteratsii paratimpanal'nykh prostranstv u bol'nykh s kholesteatomoi.

INTRODUCTION: On the one hand, open-type surgical modalities have the advantage of the low frequency of relapses; on the other hand, they lead to the undesirable changes in the anatomical and physiological characteristics of the ear that in the long run create serious problems for both the doctor and the patient. In contrast, the closed-type surgical interventions are associated with a more favourable hygienic status and functional outcome but create a high risk of development of recurrent and residual cholesteatomas. The disadvantages of both types of cholesteatoma surgery motivated the surgeons for the development of the 'hybrid' approaches combining the advantages of open and closed strategies. The obliteration of the paratympanic spaces is one of them. AIM: The objective of the present study was to evaluate the results of the surgical treatment of recurrent and residual cholesteatomas and to optimize the algorithm of the postoperative control with the use of MRI in the non-EPI DWI regime. MATERIAL AND METHODS: The retrospective analysis of the available clinical materials covering the period from 2009 to 2014 included the results of the surgical treatment of the patients suffering from chronic otitis media and cholesteatoma with the use of the method for the obliteration of the paratympanic spaces. RESULTS: A total of 179 patients were operated using the obliteration technique. The patients were under observation for 34 months on the average. We used the otomicroscopy and MRI in the non-EPI DWI regime to examine the patients within 1, 2, and 3 years after surgery. The residual cholesteatoma was discovered in 15 (8.4%) patients out of the total 179 ones. The cases of recurrence of the cholesteatomas were not observed. The diagnostic effectiveness of MRI in the non-EPI DWI regime was estimated for the purpose of the postoperative control. Sensitivity of the method was 93.3%, specificity - 97.1%.

The role of subtotal petrosectomy in cochlear implant recipients.

Describe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the remaining 2 cases was asymmetric hearing loss or unilateral hearing loss. The reason for performing a subtotal petrosectomy was chronic otitis media with or without cholesteatoma, radical cavities from previous surgeries or electrode extrusion of previously implanted devices. All cases were performed in one stage. One patient had an infectious complication that required revision surgery and finally an explantation. No other complications are described. Subtotal petrosectomy combined with cochlear implantation is a procedure required in certain situations. It is an effective and safe procedure for managing middle ear problems and creating a safe cavity to receive a cochlear implant either in adults and children.

Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients.

This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air-bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n = 73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n = 23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p = 0.012, 95% CI 1.3-10.3). Complete failure to manage infection significantly differed (p = 0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.

Quality of life after cholesteatoma surgery: intact-canal wall tympanoplasty versus canal wall-down tympanoplasty with mastoid obliteration.

OBJECTIVES: The aim of this study was to evaluate, by means of the Chronic Ear Survey (CES), the quality of life of patients who had undergone either intact-canal wall tympanoplasty (ICWT) or canal wall-down tympanoplasty (CWDT) with mastoid obliteration. METHODS: This was a retrospective case review study performed at a tertiary referral center. Among 379 patients affected by middle ear and mastoid cholesteatoma operated on between November 2000 and December 2009, 50 patients who underwent ICWT and 50 who underwent CWDT with mastoid obliteration were randomly selected. The CES scores were analyzed for both groups. RESULTS: The mean scores on the CES were 6.5 ± 2.1 in patients who underwent CWDT and 6.9 ± 2.2 in patients treated with ICWT (t = -0.93; p > 0.05). No significant differences between the two groups were found on the activity restriction, symptom, or medical resource subscales (p > 0.05). CONCLUSIONS: The results of this study demonstrate that CWDT with mastoid obliteration resulted in a quality of life comparable with that after ICWT. Postoperative hearing loss is the most frequently reported problem for both techniques.

Comparative Analysis of Various Materials Used for Mastoid Cavity Obliteration in Canal Wall Down Mastoid Surgery.

To study the surgical result and efficacy of different methods of mastoid obliteration with cavity care. This prospective study included 60 patients who had cholesteatoma, conducted in the Department of Ear Nose and Throat (ENT), Institute of Medical Sciences, Banaras Hindu University, Varanasi from July 2015 to July 2017. The mastoid cavity was obliterated with either muscle flap/bone dust/hydroxyapatite. detailed history otoscopic examination was done pre-operatively and follow up were recorded at 1 month and 3 months in postoperative period. 60 patients were included, who underwent canal wall down mastoid surgery. each group muscle flap (group 1), bone dust (group 2) and hydroxyapatite (group 3) included 20 patients, age group 31-40 year with its maximum incidence of 43.3%, Preop PTA value were almost equal in all group but on comparison at 1 month in postoperative period significant improvement was present in group 1 versus 2(0.021) and group 2 versus 3(0.003) but not in group 1 versus 3. Although at 3 month there were significant improvement was present in all groups. The incidence of pain, discharge, giddiness and wax formation were markedly reduced and healing of cavities was early and better in obliterated cavities done by muscle flap and bone dust material as compared to hydroxyapatite cavities, at the end of 3 months. outcome and quality of life was better and almost equal in muscle flap and bone dust material group as compared to hydroxyapatite group.

Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach.

OBJECTIVE: To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children. METHODS: Review of children with primary acquired or congenital cholesteatoma. Severity was classified by extent and EAONO-JOS stage, and surgery by SAMEO-ATO. Primary outcome measure was 5-year recurrence rate using Kaplan-Meier or Cox regression analysis. RESULTS: Median age was 10.7 years for 408 cholesteatomas from which 64 recurred. Median follow up was 4.6 years (0-13.5 years) with 5-year recurrence rate of 16% and 10-year of 29%. Congenital cholesteatoma (n = 51) had 15% 5-year recurrence. Of 216 pars tensa cholesteatomas, 5-year recurrence was similar at 14%, whereas recurrence from 100 pars flaccida cholesteatomas was more common at 23% (log-rank, p = 0.001). Sub-division of EAONO-JOS Stage 2 showed more recurrence in those with than without mastoid cholesteatoma (22.1% versus 10%), with more in Stage 3 (31.9%; p = 0.0003). Surgery without mastoidectomy, including totally endoscopic ear surgery, had 11% 5-year recurrence. Canal wall-up tympanomastoidectomy (CWU) and canal wall-down/mastoid obliteration both had 23% 5-year recurrence. Multivariate analysis showed increased recurrence for EAONO-JOS Stage 3 (HR 5.1; CI: 1.4-18.5) at risk syndromes (HR 2.88; 1.1-7.5) and age < 7 years (HR 1.9; 1.1-3.3), but not for surgical category or other factors. CONCLUSION: Young age and more extensive cholesteatoma increase the risk of recurrent cholesteatoma in children. When controlling for these factors, surgical approach does not have a significant effect on this outcome. Other objectives, such as lower post-operative morbidity and better hearing outcome, may prove to be more appropriate parameters for selecting optimal surgical approach in children.

Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes.

Objectives: The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques. Methods: A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) (p = 0.013). Interventions: All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma. Main outcome measures: The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing. Results: In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903). Conclusions: Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.

Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis.

OBJECTIVE: Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data. METHODS: The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified. RESULTS: A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. CONCLUSION: Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data. LEVEL OF EVIDENCE: NA Laryngoscope, 133:1297-1305, 2023.

The effect of bony obliteration on quality of life after tympano-mastoidectomy surgery: A prospective observational controlled cohort study.

Objectives: The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. Methods: A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. Results: The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). Conclusion: There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. Level of Evidence: 1b (individual prospective cohort study).

Comparative Study of Various Techniques of Mastoid Obliteration following Canal Wall Down Mastoidectomy.

The primary objective of mastoid obliteration is the eradication of the disease and prevention of its recurrence. We intend to evaluate the impact of mastoid obliteration using autologous materials on the achievement of a dry mastoid bowl and frequency of maintenance care and hearing outcome of the operated ear. This was a hospital-based, non - randomized, prospective study. The study was performed over a period of 2 years. The study was performed in the Department of ENT of a tertiary care teaching hospital. Patients of chronic otitis media - squamosal type underwent canal wall down mastoidectomy and patients were divided into 2 groups of obliterated and non-obliterated. The canal wall obliterated patients were further compared in 3 groups based on the technique of mastoid obliteration used - bone dust, musculo-periosteal flap and cartilage graft. 6 months post-operative mastoid cavity epithelisation based on oto-microscopy and hearing outcome based on pure tone audiometry findings were compared. Majority of patients at 6-months follow-up found that epithelization was most common status of mastoid cavity with musculoperiosteal flap and discharge was commonest with cartilage graft. Mastoid obliteration with autologous materials is a safe and effective method to achieve a dry, safe and useful ear. In this study, musculo-periosteal flap being significantly better in terms of a well epithelized cavity and hearing outcome.