Learning Objectives:
Background: The primary goal of cholesteatoma surgery is complete eradication of the disease and to produce a dry, healthy ear. A mastoid cavity following canal wall down surgery can result in major morbidity due to chronic otorrhoea and infection, difficulty with hearing aids, and vertigo with temperature changes, particularly when concomitant meatoplasty is performed. Mastoid obliteration with reconstruction of the bony external ear recreates normal anatomy to avoid such morbidity (and obviates the need for soft tissue meatoplasty). Bone pâté reconstruction is one of the surgical options but some controversy persists in its admixture with Sofradex®, with suggestions that this may induce a sensorineural hearing loss.
Aim: To examine the curative and hearing effect of the use of Sofradex®/autologous bone pâté for posterior canal wall and attic reconstruction following mastoidectomy in consecutive patients.
Method: Retrospective case series; autologous bone pâté was used in conjunction with Sofradex® in all cases.
Results: 28 patients were identified. Mean preoperative and postoperative bone conduction thresholds were 15.5 and 18.3 dB respectively (paired t test, p = 0.12, non-significant). Mean preoperative and postoperative air conduction thresholds were 44.6 and 44.8 dB respectively. Follow up ranged from 6–36 months, with a median of 12 months. All patients had a dry, healthy ear at long term follow up. There have been no cases of recurrent or residual cholesteatoma thus far.
Conclusion: Mastoid and epitympanic obliteration with autologous bone pâté and Sofradex® is a safe and effective technique. There is no current evidence that demonstrates sensorineural hearing loss with the concomitant use of Sofradex®.
