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Controversy has raged for many years between open mastoid cavity procedures and canal wall up techniques in terms of postoperative recidivism and ear discharge. It is generally believed that canal wall up procedures can miss hidden cholesteatoma but preserve useful and functional anatomy. Mastoidectomy is more comprehensive in clearing cholesteatoma but, in its wake, leaves an altered quality of life due to the mastoid cavity and hearing loss. Therefore, can mastoidectomy with obliteration be a solution to this?

This study comprises a cohort of 98 patients and 104 operations. Recidivism was noted in 16.3% of the 49 patients who had canal wall up procedure and in 7.3% of 55 patients who underwent mastoidectomy and obliteration, the difference being statistically significant.

The rate of post-surgery discharge was higher, though not significantly so, in the canal wall up group. The hearing outcomes were similar in the two groups. The two groups were well matched in terms of the extent of cholesteatoma. Few studies have compared the CWU technique directly with mastoidectomy and obliteration in an adult population. The numbers, though small, have produced a statistical conclusion for recidivism. The selection of surgery seems to be an individual preference. The more recent use of KTP laser and otoendoscopes has not been factored into the equation. However, this is an interesting reading offering good practicalities.

Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery.
Wilkie MD, Chudek D, Webb C, Panarese A, Bahnegy G.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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