Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

Antibiotics in mastoid and epitympanic obliteration with S53P4 bioactive glass: A retrospective study

Objective

The role of antibiotics in ear surgery is still controversial. The aim of this study was to assess their need in cholesteatoma surgery when performing obliteration with S53P4 bioactive glass, a biocompatible material with antibacterial properties.

Methods

This retrospective cohort study was conducted in a tertiary referral center between January 2017 and May 2019. Sixty-nine consecutive patients, who underwent surgery for cholesteatoma removal and/or rehabilitation of canal-wall-down mastoidectomy with mastoid and epitympanic obliteration using S53P4 granules were included. Before 2019, antibiotics were routinely used (group "w/AB"). Patients received intravenous antibiotics during surgery, oral treatment was continued for 7 days and topical antibiotics for 1 month. After 2019, no antibiotics were administered (group "w/oAB"). The primary outcome was the occurrence of early surgical site infection. Secondary outcomes were late infection, anatomic and functional results at 3 and 12 months.

Results

Twenty-three patients were included in group "w/oAB" and 46 in group "w/AB", with no significant differences in demographics, medical history or follow-up. Five ears (22%) in group "w/oAB" developed an early infection compared with 2 (4%) in group "w/AB" (p = .03). The relative risk was 6.11, 95CI%[1.09;31.96]. Infections were successfully treated with antibiotics, and no patient underwent surgical removal of the granules. No late infections or complications were observed. There was no difference in graft failure or air-bone gap closure at 1 year.

Conclusion

Peri-/post-operative antibiotics prevent early infection in obliteration surgery with S53P4 granules. Infections can be treated medically without complications or require removal of the implanted material.

Level of evidence

4.

Implantation of two generations of Bonebridge after mastoid obliteration with bioactive glass S53P4

PURPOSE

After radical surgery for chronic cholesteatoma (CWD mastoidectomy), patients have the option to have the posterior wall of their external auditory canal surgically reconstructed with S53P4 bioactive glass. The procedure eliminates some of the restrictions related to having a postoperative cavity and extends the options for a hearing prosthesis. If classic reconstruction is not possible and a hearing aid is not used, we suggest use of a Bonebridge implant.

METHODS

This study describes, over 18 months of follow-up, 16 patients after a two-stage surgical procedure: obliteration of the mastoid cavity with bioactive glass followed by Bonebridge implantation. There were 7 patients who received the first generation implant (BCI 601) and 9 who used the second (BCI 602). Before and after implantation, pure tone audiometry, sound field thresholds, and free-field audiometry were performed. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire.

RESULTS

During the observation period, no serious complications were found. The study demonstrated the safety and validity of the procedures and confirmed the safety of using S53P4 bioactive glass in otosurgery (antibacterial effect, nonrecurrence of cholesteatoma, and no effect on the inner ear). The audiological benefits expected from using the Bonebridge implant processor were also confirmed.

CONCLUSION

It is concluded that, after reconstructing the posterior wall of the external auditory canal with bioactive glass, two-stage implantation of a Bonebridge implant in a typical site is a safe solution for patients who have difficult anatomical conditions following their CWD mastoidectomy.

Sublabial bioactive glass implantation for the management of primary atrophic rhinitis and empty nose syndrome: Operative technique

OBJECTIVES

Atrophic rhinitis (AR) and empty nose syndrome (ENS) are chronic diseases characterized by a paradoxical nasal obstruction. These rare syndromes tend to occur after nasal surgery of the inferior turbinates in ENS and can be idiopathic in AR. Medical treatments alone are often insufficient. Surgical options are challenging and numerous resorbable and nonresorbable implants have been described in small series, with as many surgical techniques described. Whereas current surgical procedures are for risk of extrusions, graft rejections or poor lasting results, the use of GlassBONE™ (Sodimed®, Avignon, France), a bioactive glass, for a vestibular approach in AR and ENS has never been reported for this indication.

METHODS

We described an original technique of nasal submucoperiosteal bilateral ceramic glass implantation in two patients with AR and ENS.

RESULTS

The two cases presented a postoperative satisfying endoscopic and sinus CT-scan results with filling of the nasal cavities, with less crusts and a complete wound healing. They had no short-term complications.

CONCLUSION

This innovative approach is easily feasible and could be an option considered for the surgical management of AR and ENS. Level of evidence: 4.

The Viability and Growth of HaCaT Cells After Exposure to Bioactive Glass S53P4-Containing Cell Culture Media

HYPOTHESIS

Bioactive glass (BG) S53P4 reduces the viability of epidermal keratinocyte-derived immortalized cell line, HaCaT in sufficient concentrations in vitro.

BACKGROUND

Although used in mastoid obliteration surgery, there is no data available on whether BG S53P4 granules have an inhibitory or excitatory effect on keratinocytes, found in normal skin and ear cholesteatoma in vivo.

METHODS

HaCaT cell cultures were incubated with a direct BG S53P4 granule contact. Microscopic evaluation of the cultures was performed and interleukin-6 (IL-6) and -8 (IL-8) concentrations were measured from the medium samples. In addition, BG granules were incubated in two cell culture media for 6 days and the pure media were used in confluent HaCaT cultures preceding cell viability assay. Finally, a scratch assay test was performed to reveal the possible BG effect on HaCaT cultures.

RESULTS

Eight to ten cell thick layers of dead HaCaT cells were noticed after a 2-day BG granule contact. With a BG concentration of 2.5%, IL-6 and IL-8 concentrations were smaller compared with the control group without BG after 2 days' incubation. Overall, HaCaT cell viability decreased when BG was incubated in keratinocyte growth medium, but did not change in Dulbecco's modified Eagle's medium. In a scratch assay test, cell regrowth in the scratch area was notable in cultures without BG.

CONCLUSIONS

BG S53P4 seems to have an inhibitory effect on HaCaT cell growth. Although further studies are needed, this observation seems advantageous for cholesteatoma treatment.

Implantation of the Bonebridge BCI 602 after Mastoid Obliteration with S53P4 Bioactive Glass: A Safe Method of Treating Difficult Anatomical Conditions-Preliminary Results

This study presents the preliminary results of a new otosurgical method in patients after canal wall down (CWD) surgery; it involves the implantation of the Bonebridge BCI 602 implant after obliteration of the mastoid cavity with S53P4 bioactive glass. The study involved eight adult patients who had a history of chronic otitis media with cholesteatoma in one or both ears and who had had prior radical surgery. The mean follow-up period was 12 months, with routine follow-up visits according to the schedule. The analysis had two aspects: a surgical aspect in terms of healing, development of bacterial flora, the impact on the inner ear or labyrinth, recurrence of cholesteatoma, and possible postoperative complications (firstly, after obliteration of the mastoid cavity with S53P4 bioactive glass, then after implantation). The second was an audiological aspect which assessed audiometric results and the patient’s satisfaction based on questionnaires. During the follow-up period, we did not notice any serious postoperative complications. Studies demonstrated significantly improved hearing thresholds and speech recognition in quiet and noise using the Bonebridge BCI 602. Data collected after six months of use showed improved audiological thresholds and patient satisfaction. Based on the preliminary results, we believe that the proposed two-stage surgical method using bioactive glass S53P4 is a safe and effective way of implanting the Bonebridge BCI 602 in difficult anatomical conditions. This makes it possible to treat a larger group of patients with the device.

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).

Disease-specific quality of life and psychological distress after endoscopic tympanoplasty

PURPOSE

To assess the postoperative quality of life (QoL) of patients operated on for chronic otitis media (COM) and cholesteatoma by endoscopic approach, with respect to disease-specific complaints and psychological distress, using two validated questionnaires: Chronic Ear Survey (CES) and Depression Anxiety Stress Scale-21 (DASS-21).

METHODS

Eighty-five consecutive patients operated on for cholesteatoma and COM by endoscopic tympanoplasty from March 2018 to February 2020 filled in CES and DASS-21, within one month prior to surgery. A second administration of each questionnaire was performed at the yearly postoperative evaluation. A multivariate analysis using a linear regression model was performed to evaluate the role of the different variables associated with the questionnaires' subscales and overall scores.

RESULTS

A significant improvement was achieved in all CES and DASS-21 subscales after endoscopic tympanoplasty. No patient showed a DASS-21 score compatible with a psychological distress both at the pre- and postoperative assessments. At multivariate analysis, the only significant factors associated with postoperative improvement in CES scores were preoperative DASS-21 "depression" score and months of follow-up.

CONCLUSION

Endoscopic tympanoplasty shows significantly improved QoL as assessed by disease-specific and psycho-emotional questionnaires. A subjective favourable effect of fully endoscopic ear surgery was demonstrated.

Tolerance and safety of 45S5 bioactive glass used in obliteration procedures during middle ear surgery: Preliminary results

OBJECTIVE

Otologists face many disadvantages after extensive mastoid drilling and canal wall down technique in cholesteatoma surgery. Mastoid and epitympanic cavity obliterations or reconstructions after canal wall down procedure using bioactive glass seem to be an interesting solution to overcome some of these disadvantages. Bioactive glass offers many benefits including the availability when there are no sufficient autologous materials for obliteration, its antibacterial activity in chronic infected ear and decreasing the recidivism of cholesteatoma. The objective of this study is to evaluate the tolerance and safety of 45S5 bioactive glass as a filing bone-synthetic material by clinical, audiological and radiological examinations.

METHODOLOGY

A retrospective study of 42 patients who had undergone obliteration of mastoid or/and epitympanic cavity with 45S5 bioactive glass between, November 2017 to January 2019. Data from clinical follow-ups, audiological assessment, CT-scan and MRI were analyzed.

RESULT

The patients' mean age was 49.8 years old. Microscopic examinations showed dry well-healed tympanic membranes and external auditory canals for 95.2% of the patients after 1 year. Inner ear injuries after obliteration were not observed by comparing pre and post-operative bone conduction audiometry (p value 0.457). No facial palsy was reported post-operatively. One-year postoperative radiological assessments did not reveal any silent implantation of cholesteatoma or residual disease.

CONCLUSION

Mastoid and epitympanic obliterations with 45S5 bioactive glass seem to be a tolerable and safe option in cholesteatoma surgery with favorable outcomes similar to other member of bioactive glass especially the S53P4.

The bony obliteration tympanoplasty in cholesteatoma: safety, hygiene and hearing outcome: allograft versus autograft tympanic membrane reconstruction

OBJECTIVE

To evaluate early results on hygiene, safety and functional outcome in a population undergoing a canal wall up technique with bony obliteration of the mastoid and epitympanic space (CWU-BOT) for extensive cholesteatoma, performed by a single surgeon. This study compares different techniques of tympanic membrane reconstruction, viz. allografts and autografts.

PATIENTS

A consecutive series of 61 ears with acquired cholesteatoma treated with primary or revision CWU-BOT surgery from 2009 to 2014.

INTERVENTION

Obliteration was performed by the use of cortical bone-chips and bone pâté. Patients were followed up with micro-otoscopy and MRI with diffusion-weighted imaging. Ossicular reconstruction was performed using a remodelled autologous or allogenic incus or malleus.

MAIN OUTCOME MEASURES

Residual and recurrence rate and short- and mid-term hearing outcome prior to any revision tympanoplasty were analysed, the effect of type of tympanic membrane reconstruction was considered.

RESULTS

44 Ears were primary cholesteatoma cases, 17 cases were referred for revision surgery. Mean postoperative follow up was 45 months (SD 18.08) and mean follow-up until the last non-EP DW MRI 42 months (SD 17.72). Recurrent disease was present in 3%, no residual disease was present. An AC gain was seen in 75% of all ears undergoing ossicular reconstruction.

CONCLUSION

Reproducible safety, hygiene and hearing results with limited recurrence and residual disease can be obtained by younger otologic surgeons performing the BOT-CWU for extensive cholesteatoma while using a variety of grafts for tympano-ossicular reconstruction. The tympano-ossicular allograft nevertheless shows superior hearing results when a mobile intact stapes is present.

LEVEL OF EVIDENCE

Level 4.

Management of tegmen defects with mastoid and epitympanic obliteration using S53P4 bioactive glass

OBJECTIVE

To evaluate the surgical results and complications in a cohort of patients operated on to repair a tegmen bony defect using either transmastoid approach with obliteration using S53P4 bioactive glass granules (TMA-O), or the classic middle cranial fossa approach (MCFA).

STUDY DESIGN

A retrospective monocentric study.

METHODS

Twenty-five cases (24 patients) were included. Data regarding patient demographics, etiology, intraoperative findings, complications, recurrences, audiometric data, and follow-up were analyzed.

RESULTS

Seven patients were operated with MCFA and 17 patients with TMA-O. One patient was operated on using a combined approach (MCFA + TMA-O). In the preoperative HRCT scan, the size of the defect was estimated to be 6 ± 3.8 mm in the TMA-O group and 6 ± 3.5 mm in the MCFA group (P = .969). Intraoperatively, in the MCFA group, the location of the defect was mostly anterior (86%) with an intact ossicular chain (86%). A discontinuous chain was observed in 15 patients (88%) in the TMA-O group. The mean follow-up time was 22 ± 14 months in the TMA-O group and 24 ± 15 months in the MCFA group (P = .762). In both groups, there were no early postoperative complications or recurrences during follow-up.

CONCLUSION

Repair of a tegmen bony defect with S53P4 bioactive glass granules seems to be safe and effective, limiting the use of the middle cranial fossa approach to cases with epitympanic defects and with an intact ossicular chain, and it could be used whatever the size of the defect and/or the presence of meningoencephalocele.

LEVEL OF EVIDENCE

4.

Anatomical and functional results of ossiculoplasty using titanium prosthesis

Titanium ossicular chain replacement prosthesis is often used for rehabilitation of the columellar effect in otologic surgeries. This retrospective study aims to analyse the anatomical and functional results of surgeries in which a titanium prosthesis was used. Two hundred and eighty procedures in 256 patients operated on in a tertiary referral center were analysed. Aetiologies, preoperative audiograms, peroperative data and postoperative outcomes at 2 and 12 months postoperatively were reviewed. Chronic suppurative otitis media with or without cholesteatoma was the main aetiology (89%). There was no difference in anatomical results between partial and total ossicular replacement prosthesis, with an overall dislocation rate of 6%, and an overall extrusion rate of 3%. Regarding functional results, a postoperative air-bone gap ≤ 20 dB was achieved in 65% of cases, with a better result for partial compared to total ossiculoplasty (p = 0.02). A significant difference in air bone gap closure was found when comparing aetiologies, with a higher air-bone gap closure in malformation cases compared to chronic suppurative otitis media with cholesteatoma or retraction cases (p = 0.03). Ossiculoplasty using titanium prosthesis is a safe and effective procedure for rehabilitation of hearing loss, which allows reaching an air-bone gap ≤ 20 dB in the majority of patients.

Bioactive glass granules for mastoid and epitympanic surgical obliteration: CT and MRI appearance

PURPOSE

To evaluate the appearance of mastoid and epitympanic obliteration using S53P4 bioactive glass (BG) granules in high-resolution computed tomography (HRCT) and MRI.

MATERIALS AND METHODS

Patients undergoing mastoid and epitympanic obliteration between May 2013 and December 2015 were prospectively included in an uncontrolled clinical study. All patients underwent a temporal HRCT scan 1 year after surgery, aimed at evaluating the attenuation, homogeneity, and osseointegration of the BG granules, as well as the ventilation of the middle ear and the volume of the obliterated paratympanic spaces. If a cholesteatoma was found during surgery, additional MRI, including at least pre- and post-contrast T1-weighted, T2-weighted, and axial non-echo-planar diffusion-weighted (DW) sequences, was performed 1 year after surgery, to study the normal signal of the BG granules and the presence of residual cholesteatoma and/or other temporal bone pathologies.

RESULTS

Seventy cases were included. On 1-year HRCT, the mean attenuation of the BG granules was 888.34 ± 166.10 HU. The obliteration was found to be mostly homogeneous with partial osseointegration. The appearance of the BG granules having a low-intensity signal in T2-weighted imaging and DW MRI was always different from the appearance of cholesteatoma. A longer follow-up has shown no attenuation or signal modification of the BG granules compared with the 1-year imaging.

CONCLUSION

Radiological follow-up of patients operated on with mastoid and epitympanic obliteration using BG granules is effective using both HRCT and MRI. A cholesteatoma and/or other potential complications could easily be detected due to the specific radiological appearance of the BG granules.

KEY POINTS

• The appearance of mastoid and epitympanic obliteration by S53P4 bioactive glass (BG) granules on high-resolution computed tomography (HRCT) scans was homogeneous with an attenuation significantly higher than the attenuation of cholesteatoma and lower than mastoid bone attenuation. • The granules have a low-intensity signal on non-echo-planar diffusion-weighted sequences and on T2-weighted images and present contrast enhancement allowing the differential diagnosis with cholesteatoma and effective for the detection of other underlying temporal bone pathologies. • The volume and radiological appearance of the obliteration appear to be stable with time.

Osteotomy Site Grafting in Bilateral Sagittal Split Surgery With Bioactive Glass S53P4 for Skeletal Stability

In orthognathic surgery, the aim of the treatment is to achieve a good occlusion and a satisfying aesthetic outcome. In large mandibular advancements insufficient healing at the mandibular inferior border may lead to loss of support for the overlaying tissue at the osteotomy site. Augmentation can be performed to improve stability, bone regeneration, and the aesthetic outcome. The purpose of this prospective clinical study was to evaluate the use of a novel material for this indication; granules of the antibacterial, osteoconductive, and slowly resorbing bioactive glass S53P4 as filling material in large mandibular advancement in bilateral sagittal split osteotomies. The authors treated 25 patients who underwent bilateral sagittal split osteotomies due to class II dentoskeletal deformities. The mandibular osteotomy site defects (8-15 mm) were augmented with bioactive glass S53P4. The average clinical follow-up was 33 months and the average radiological follow-up with cone beam computerized tomography was 24 months. The clinical and radiological results were good with regard to healing, bone regeneration, and stability of the osteotomy sites. The recontouring of the inferior mandibular border provided a good soft tissue support followed by an excellent aesthetic outcome in 96% of the osteotomy sites. The occlusion was stable in 88% of the patients. The authors' results show that bioactive glass S53P4 is a safe grafting material for osteotomy site defects in significant mandibular advancements with reliable bone regeneration, providing long-term stability at the osteotomy site and at the inferior mandibular border.

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.

Mastoid obliteration with S53P4 bioactive glass in cholesteatoma surgery

CONCLUSION

Evaluation of the follow-up of 67 patients shows that S53P4 bioactive glass (BAG) granules are safe and effective as obliteration material in cholesteatoma surgery.

OBJECTIVES

To investigate the safety and efficacy of mastoid obliteration using S53P4 BAG in cholesteatoma surgery. Clinical outcomes were infection control (Merchant's grading), cholesteatoma recidivism, and audiometric performance.

METHODS

Retrospective follow-up study at the Diakonessenhuis, Utrecht, the Netherlands. Eighteen young (age <17 years) and 49 adult (age ≥17 years) patients treated for cholesteatoma underwent tympanomastoidectomy with mastoid obliteration using S53P4 BAG in the period 2012-2015. Outcome was monitored with clinical otoscopy, otorrhea incidence measurement (Merchant's grading), DW-MRI, and audiographic performance analyses (pure tone average and air bone gap).

RESULTS

During the follow-up period (mean = 22 months; range = 12-54 months) cholesteatoma recidivism was observed in 6% of the patients (four ears), mostly in young patients (three ears). An acceptably dry ear (Merchant grade 0-1) was achieved in 96% of all cases. The remaining 4% of cases scored a Merchant grade 2. Overall, both air conduction thresholds and air bone gap were slightly lowered when comparing post-operative values to pre-operative values and significantly in the case of ossicular reconstruction. In none of the patients (0%) did post-operative wound infections occur.

Anatomical, functional and quality-of-life results for mastoid and epitympanic obliteration with bioactive glass s53p4: a prospective clinical study

OBJECTIVE

To analyse the anatomical, functional and quality-of-life results when using bioactive glass in mastoid and epitympanic obliteration.

DESIGN

Prospective clinical study.

SETTING

Tertiary referral centre.

PARTICIPANTS

Forty-one cases (39 patients) operated between May 2013 and January 2015.

MAIN OUTCOME MEASURES

Anatomical results were evaluated by otomicroscopy 1 year after surgery and using imaging to detect residual disease. Functional results were studied by postoperative hearing gain. Quality of life was assessed with the Glasgow Benefit Inventory questionnaire and the success of surgery by a surgery-specific questionnaire.

RESULTS

At 1 year, all patients presented a well-healed external auditory canal, with an intact tympanic membrane. In cases with cholesteatoma (n = 23), no recurrent retraction pockets or residual disease were observed on imaging studies. The overall air-bone gap closure was 7.7 ± 1.84 dB (mean ± se of the mean, P < 0.001, paired t-test). No significant differences were found on hearing results when comparing primary versus revision surgery, canal-wall-up versus canal-wall-down obliterations, type of tympanoplasty and presence of cholesteatoma (multifactor anova). The Glasgow Benefit Inventory improved with an average score of 28 and the success of surgery questionnaire showed a significant improvement in ear discharge and a moderate improvement in hearing and equilibrium.

CONCLUSIONS

The use of bioactive glass for mastoid and epitympanic obliteration in canal-wall-down or canal-wall-up tympanoplasties is an effective procedure in both primary and revision surgery. The anatomical and functional results appear to be well correlated with patient experience and to the improvement in quality of life.

Canal reconstruction and mastoid obliteration using floating cartilages and musculoperiosteal flaps

OBJECTIVES

To reduce the mastoid cavity-associated problems secondary to canal wall down mastoidectomy, we designed a new surgical procedure that includes canal wall reconstruction using free-floating cartilages and double musculoperiosteal flaps.

STUDY DESIGN

Retrospective study.

MATERIALS AND METHODS

Thirty-three patients were enrolled in this study. Preoperative and postoperative pure tone audiometry/speech discrimination score and postoperative status (complications and EAC status) were analyzed.

RESULTS

Air conduction thresholds were statistically improved (P = 0.008). The air-bone gap was significantly reduced following surgery (P = 0.001). There were no other major complications in any of the patients. Long-term follow-up demonstrated gradual widening of the neo-EAC in 18 patients (54.5%) but normal contour of the neo-EAC in the other 13 patients (39.4%). In just one case did the neo-EAC become extremely widened.

CONCLUSION

Mastoid obliteration and canal wall reconstruction using free-floating cartilages and double musculoperiosteal flaps is very useful to achieve optimal surgical view, eliminate the middle ear pathology, and prevent recurrence of cholesteatoma and cavity problem.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1153-1160, 2017.