Mastoid Obliteration Could Be Effective in Cholesteatoma Surgery, but More Data Are Needed

How effective is mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery?

BOTTOM LINE

Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique.

BACKGROUND: In cholesteatoma surgery, the two traditional surgical techniques are CWU, which keeps the posterior wall of the outer ear canal intact, and canal wall down (CWD), in which the posterior wall is removed. Mastoid obliteration tries to combine the advantages of both and helps in reconstructing the posterior wall.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.

SYNOPSIS: Researchers conducted a database search for studies on patients who received tympanomastoid surgery due to cholesteatoma and were followed for at least 12 months post-surgery. The primary outcome was recidivism, including the proportion of recurrent and residual disease. The second outcomes were quality of life, hearing results, infection rates, operation times, and rate of ear discharge. A total of 11 articles, all retrospective cohorts, comprising data on 2,077 operations, met criteria for systematic review. Results showed the odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU. When separated, however, the proportion of ears with recurrent or residual disease did not show a significant difference despite similar odds. A qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. Authors emphasized that the results were based on a minimum follow-up of one year and that surveillance would be optimal above this time limit. Study limitations included the use of only retrospective observational studies with several confounding factors and a serious risk of bias.

CITATION: Illés K, Meznerics FA, Dembrovszky F, et al. Mastoid obliteration decreases the recurrent and residual disease: systematic review and meta-analysis. Laryngoscope. 2023;133:1297–1305.