During the last 50 years, the debate over the merits of canal-wall-up (CWU) versus canal-wall-down (CWD) surgery for removing pediatric cholesteatomas has shifted focus several times.
Explore this issue:May 2010
The traditional pro/con arguments are familiar to most otolaryngologists. The major advantage of the CWU procedure is that it preserves the canal wall and other key structures of the middle ear. That preservation enables patients to get the ear wet and eliminates the need for repeated cleaning of the large surgical cavity left behind by the more invasive CWD approach. Hearing results are also purported to be better in CWU-treated patients, although studies are split on whether that is truly a distinguishing factor.
The major downside to the CWU approach is a high rate of recurrent disease, ranging up to 50 percent in some studies and clinical experience. The recurrences often occur because it is difficult to see the entire middle ear and epitympanum when the canal wall is left intact during surgery. As a result, disease is left behind and can recur six to 12 months later.