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Review
March 15, 2018

Single-Stage Mastoid Obliteration in Cholesteatoma Surgery and Recurrent and Residual Disease RatesA Systematic Review

Author Affiliations
  • 1Department of ENT, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA Otolaryngol Head Neck Surg. Published online March 15, 2018. doi:10.1001/jamaoto.2017.3401
Key Points

Question  What are the recurrent and residual cholesteatoma rates after canal wall up and canal wall down tympanoplasty with mastoid obliteration?

Findings  In this systematic review of 22 articles, 1534 patients underwent a canal wall down or canal wall up tympanoplasty with mastoid obliteration with an overall recurrent disease rate of 4.6% and an overall residual disease rate of 5.4%. In canal wall up tympanoplasty with mastoid obliteration, these rates were 0.28% and 4.2%, respectively, and in canal wall down tympanoplasty with mastoid obliteration 5.9% and 5.8%, respectively.

Meaning  Recurrent and residual cholesteatoma rates after either canal wall up or canal wall down tympanoplasty with mastoid obliteration are qualitatively similar, if not better than previously reported rates for nonobliterative techniques.

Abstract

Importance  The ideal surgical treatment of cholesteatoma has been subject to discussion for years because both traditional surgical techniques (canal wall down [CWD] and canal wall up [CWU] tympanoplasty) have their own advantages and disadvantages. A more recently propagated surgical approach, to combine the CWD or CWU tympanoplasty technique with obliteration of the mastoid and epitympanum, is showing promising results.

Objective  To systematically review the literature on recurrent and residual cholesteatoma rates after single-stage CWU and CWD tympanoplasty with mastoid obliteration.

Evidence Review  A systematic search of literature was performed to identify relevant publications in multiple electronic databases. The initial search was conducted in December 2016 and was updated in July 2017. Each study was reviewed by 2 independent reviewers on predetermined eligibility criteria. The methodological quality was determined using the methodological index for nonrandomized studies (MINORS) scale, and the relevance to the current topic was determined using a 4-criterion checklist.

Findings  The searches identified a total of 336 potentially relevant publications; 190 articles were excluded based on title and abstract. The full-text articles of the remaining 146 citations were assessed for eligibility, resulting in 22 articles. After assessing these remaining articles for methodological quality and relevance to the current topic, another 8 studies were excluded, and a total of 13 studies (1534 patients) were included. Of the 1534 patients who underwent CWD or CWU tympanoplasty with mastoid obliteration, the rate of recurrent disease was 4.6%, and the rate of residual disease was 5.4%. In CWU tympanoplasty with mastoid obliteration, these rates were 0.28% and 4.2%, respectively and in CWD tympanoplasty with mastoid obliteration, 5.9% and 5.8%, respectively.

Conclusions and Relevance  We show the recurrent and residual disease rates after either CWU or CWD tympanoplasty with mastoid obliteration to be qualitatively similar to, if not better than, previously reported rates of for nonobliterative techniques. In this study, the lowest recurrent and residual rates were reported when combining the CWU tympanoplasty with mastoid obliteration, on average 0.28 and 4.2%, respectively.

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