Revision surgery for chronic otitis media: characteristics and outcomes in comparison with primary surgery.
ABSTRACT To analyze the characteristics and outcomes of revision surgery for chronic otitis media (COM) with or without cholesteatoma, and to compare with those of primary surgery.
A retrospective chart review was performed on 208 patients who underwent revision surgery for COM over an 8-year period (1997-2004) and 51 patients who underwent a primary canal wall down mastoidectomy (CWDM), and were followed for more than 12 months.
Recurrent or residual cholesteatoma was found in 49.5% of cases. The mastoid tip and perisinal air cells were the most frequent sites of residual air cells. As a result of revision surgery, a dry and safe ear was achieved in 88.5% of patients. A residual air-bone gap (ABG) of <or=30 dB was achieved in 70.1% of cases with a revision CWDM with ossiculoplasty. In comparison with 51 patients who underwent primary CWDM, the disease control rate was not different. However, postoperative hearing result after ossiculoplasty was worse and longer healing time was required after revision surgery.
The characteristics and surgical outcome of recurrent COM must be fully understood for complete control of the disease.
Article: Choice of approach for revision surgery in cases with recurring chronic otitis media with cholesteatoma after the canal wall up procedure.[show abstract] [hide abstract]
ABSTRACT: Cholesteatoma has a tendency to recur if not properly eradicated. This study sought to investigate and compare the outcome of the canal wall up (CWU) versus the canal wall down (CWD) procedure for recurrent cholesteatoma after initial canal preserving surgery. Between January 1990 and August 2007, 42 patients who underwent a revision tympanomastoidectomy for a recurred cholesteatoma were analyzed retrospectively. All patients initially underwent the canal wall up procedure. Recurrence rates, audiologic outcomes, and the extent of recurrent/residual cholesteatoma were investigated, and the revision surgical methods were compared. The mean follow-up duration was 10 years (range, 13 months-15.6 years). The CWD procedure was performed in 29 (69%) patients with a recurred cholesteatoma and the CWU procedure in 13 (31%) as a first revision procedure. CWD surgeries were performed in more severe cases. A second revision surgery was required in five (12%) patients. Extended cholesteatoma recurrences were observed even among cases with a lower disease stage at the time of primary surgery. The second recurrence rate was significantly higher in the CWU group than the CWD group (p=0.026). The 8-year disease-free follow-up rate in the CWD group was significantly higher than the CWU group (p=0.002). Postoperative AB gap closure was significantly better in the CWU group than CWD group (p=0.001). The CWD procedure is a safer and more successful method for controlling recurrent cholesteatoma. Thus, surgeons should not be hesitant to perform the CWD procedures for revision cases.Auris, nasus, larynx 04/2011; 38(2):190-5. · 0.58 Impact Factor