Learning Objectives: Obliteration of radical cavities in canal-wall down (CWD) operations due to cholesteatoma with autologous cortical bone chips, bone pate and meatally-based musculoperiosteal (Palva) flap technique is safe and considerably stable in terms of cavitation and hearing outcome. In our material, no intracranial complications due to hidden residual cholesteatoma have been observed.
In Helsinki University Hospital we are used to obliterate radical cavities in canal-wall down (CWD) operations due to cholesteatoma with autologous cortical bone chips, bone pate and meatally-based musculoperiosteal (Palva) flap technique. In this study we retrospectively evaluated 70 patients operated in our institution during 1986–1991 with a mean follow-up of 18 years. Outer ear canal configuration was evaluated with a modified Likert scale (1–4) and outer ear canal physical volume assessed by tympanometry. The posterior wall of the ear canal and the attic region were analyzed separately. The posterior wall results were 1.8 ( ± 0.9 SD) in Likert scale and the attic region 1.8 (± 0.9 SD) indicating no cavity formation or minor formation of a cavity. The functional result was usually good. The mean volume of the operated ear canal was 1.7 (± 0.5 SD) ml. The volume of the contralateral ear canal was 1.2 (± 0.3 SD) ml. One tympanic membrane perforation was seen. An aerated tympanum was found in 52 patients and an adhesive tympanum was found in 18 patients. In audiometry a comparison of the current mean ABG to the preoperative mean ABG and to the ABG at one-year postoperatively, 5-years postoperatively or 10-years postoperatively showed no statistical significance. 36% of the patients had an excellent or good air-bone gap closure in the operated ear after follow-up. The need for debridement generally diminished over time and 50% of the patients had no need for debridement of the cavity after 18 years’ of follow-up. To date no intracranial complications due to hidden residual cholesteatoma have been observed. In summary, our obliteration method is considerably stable in terms of cavitation and hearing outcome.
