Learning Objectives: Mastoid obliteration with posterior wall reconstruction techniques gained much popularity among the mastoid surgeon in recent years. The results published in the literature are promissing ranging between 0–15% cholesteatoma recurrences. Because of its aggressivity and irreversibility, radical mastoidectomy for cholesteatoma was totally abandoned in some institutions. This presentation describes our attitude toward this surgical trend.
Methods: The experience of the author includes 114 patients operated since 2008. The follow-up ranged between 12 months and 8 years (mean of six year and 5 months). Sixty-nine primary procedures (i.e., no previous mastoidectomy) and 45 secondary procedures (more than one previous mastoidectomy) were performed. Autologous bone was used for posterior wall reconstruction and bone pate` was used for mastoid obliteration. The results of cholesteatoma recurrences and the rate of dry ear were evaluated and compared in the two groups of patients.
Results: There were 18 cases of recurrent cholesteatoma in the total group (15.8%). Seven of them in the primary group (10.1%) and 11 in the secondary group (24.4%). Nine patients had a stubborn cholesteatoma, 4 patients of those were operated more than 3 times. Two patients finally underwent radical mastoidectomy. All cholesteatoma were located in the middle ear and no one in the obliterated mastoid. Dry ear with no need for taking precautions against water was achived in 53 of the primary group of patients (76.8%) compared to 29 in the secondary group of patients (64.4%).
Conclusions: Reconstruction techniques of the posterior wall and obliteration of the mastoid had first appeared to be the “promised land” of a solution for mastoid cholesteatoma, and raised the hopes that radical mastoidectomy surgery could be abandoned. With more experience, however it emerged that this held true solely for primary surgery. The surgical outcomes for cases of secondary cholesteatoma were worse than those achived in radical mastoidectomy. Thus, radical mastoidectomy is still indicated for stubborn cholesteatoma.
