Cholesteatoma surgery: our experience in Canal Wall Down Mastoidectomy and Tympanoplasty

Background : Cholesteatoma surgery aims to eliminate the disease, maintain a safe and dry ear and, possibly, improve functional results. Obyective :evaluate the functional results of patients with cholesteatoma who underwent canal wall down mastoidectomy with various types tympanoplasty Methods : The retrospective study -with inclusions criteria, such as absence of previous otologic surgery, one-stage surgery, two years follow-up, aerated middle ear, etc. - was carried on120 of 396 ears operated of various techniques for cholesteatoma surgery. The pathology of stapes superstructure determines the choice of the tympanoplasty technique. Patients were divided into three groups: A)a type II TPL with stapes columella reconstruction; B) a type III TPL with major columella reconstruction; and C) a type IV TPL using a temporalis fascia and thick cartilage to shield the round window. Results : The operated ears of Groups A and B, compared to Group C, presented a significant decrease in the pre-operative Air-bone gap and an increase in the number of operated ears with an Air-bone gap between 0 and 20 dB. Conclusions :The functional results confirm that the presence of an intact stapes superstructure is associated with better hearing results. Moreover, this study permit to emphasize the importance of functional separation of the two acoustic windows by fascia and cartilage graft when the stapes superstructure is missing but the footplate is mobile.