Outcome data
All cholesteatomas with LFs underwent canal wall down mastoidectomy and
primary mastoid obliteration with local tissue flaps (middle temporal
artery or inferior musculoperiosteal flaps). Middle ear reconstruction
utilized cartilage placed onto remnant stapes suprastructure if present
or stapes footplate if absent stapes. Surgeon 1 employed
complete matrix removal in 86%
(12/14) of LFs, by leaving the matrix and cholesteatoma over the SCC
till the last stage of operation, before delicately removing the matrix.
This was followed by immediate
bone-wax sealing of fistula in 50% (6/12) and temporalis fascia in 8%
(1/12). As the endosteum was intact in the remaining 5 cases, these
cases were not sealed. Surgeon 2 performed matrix preservation in the
remaining 14% (2/14) SCC fistulas. Revision mastoidectomies for
recurrent cholesteatoma were required in 14% (2/14). These 2 cases had
complete matrix removal, whereby time to recurrence was 5 years and 6
years respectively.
Postoperative
hearing PTAs were taken at a mean of 2.1 years
(1.5, 0.14-4.84). Mean
preoperative and postoperative BC thresholds were 38.4dB and 45.3dB
while AC thresholds were 73.6dB and 79.4dB respectively. 21.5% (3/14)
ears had preoperative severe to profound sensorineural hearing loss. The
remaining 11 ears were evaluated on their pre and postoperative hearing
[Table 2]. Of the 11 ears, 9 ears had their matrix completely
removed and LF repaired, and 2 ears had matrix preservation with a
modified radical mastoidectomy performed as the fistula was large.
Matrix removal group had hearing levels with no change in 78% (7/9),
improvement in 11.1% (1/12) and decreased in 11.1% (1/12). Mean
preoperative and postoperative BC thresholds were 33.1dB (17.8, 13-68)
and 38.8dB (19.3, 13-68) respectively. Postoperative hearing thresholds
done within 120 days showed worsening hearing in 22% (2/9) ears, that
subsequently had hearing restoration achieved at the last follow-up of
3.2 years and 1.6 years respectively.
The 2 LFs with matrix preservation had decreased hearing levels, after a
follow-up time of 3.2 years and 2.7 years respectively. Increase in BC
thresholds preoperatively to postoperatively were 30dB to 65dB over 2.7
years for patient 1 and 40dB to 72dB over 3.2 years for the other.