Learning Objectives: Canal Wall Down Mastoidectomy has traditionally been associated with a poorer Quality of Life, based on the limitations and restrictions resulting from the wide neo-mastoid cavity. However, according to our results, a substantial difference in the subjective perception of the post-operative outcomes between CWD and CWU should not be taken for granted.
Introduction: The benefits and disadvantages of Canal Wall Up (CWU) versus Canal Wall Down (CWD) mastoidectomy in cholesteatoma surgery have been debated for decades: comparison is mostly based on auditory results and recurrence rate. However, the most common complaint among cholesteatoma patients is daily social impediment (ear discharge, water restriction, pain, doctor visits). The aim of our study was to assess the quality of life (QOL) and hearing function in CWD vs. CWU technique.
Methods: We enrolled 81 patients subjected to mastoidectomy for cholesteatoma, at Department of Head and Neck Surgery, Catholic University, Rome (Jan 2010-Dec 2013). In 50 patients a CWD technique, without “obliteration” of the mastoid cavity, was performed (Group A) whereas 31 patients underwent a CWU technique. Pure tone audiometry (PTA) was performed 24 hours pre- and 12 months post-operatively. Chronic Ear Survey (CES) was administered 3 months after surgery. Twelve months after surgery patients were subjected to re-administration of CES together with a second questionnaire: Chronic Otitis Media Outcome Test-15 (COMOT-15).
Results: The difference between mean postoperative PTA in Group A and Group B was statistically significant (respectively 72 dB vs. 45 dB; p < 0.05). The mean CES scores were not significantly different between groups (p < 0.05), except for the subscale “Symptoms”. Also, mean COMOT-15 results didn't not significantly differ between groups (p < 0.05), except for the subscale “Hearing function”. Partial association was found between questionnaire scores and objective parameters, such as age, PTA and sex.
Conclusions: A unanimous consensus on indications and limits of CWD versus CWU technique has not yet been established. We demonstrated in our study the absence of a significant difference in terms of QOL in CWU vs. CWD.
