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Postoperative findings after mastoid obliteration (7 months after surgery). (A) Photograph of drum and external auditory canal. Reconstructed posterior wall is well maintained. (B, C) Axial and coronal temporal bone CT scan. The mastoid cavity is well obliterated by the silicone blocks (thick arrow) and bone pate (thin arrow).
Source publication
To evaluate the usefulness of silicone blocks as graft material for mastoid cavity obliteration in the prevention of problematic mastoid cavities after canal wall down mastoidectomies.
Retrospective evaluation of 20 patients who underwent mastoid obliteration with silicone blocks between 2002 and 2009 at the Chonnam National University Hospital. Th...
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Objectives:
To determine if 2Flute (Stryker Corporation, Kalamazoo, MI) otologic burs improve the size, cellular content, and bone healing of autologous cortical bone grafts harvested during canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration.
Study design:
Institutional review board-approved prospective cohort study....
Objective:
The aim of this study was to compare subepithelial angiogenesis developing within the perimatrix of the cholesteatoma between pediatric and adult patients.
Methods:
Sixty-one patients who underwent mastoidectomy for the first intent because of chronic otitis media with cholesteatoma between 1993 and 2013 and from whom appropriate tiss...
Background:
The diagnostic performance of endoscopic and microscopic procedures for detecting diseases of the middle ear in patients with chronic otitis media (COM) has rarely been investigated. This study was conducted to compare the performance of these procedures for identifying middle ear structures and their associated diseases in COM patient...
Introduction Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of m...
Mastoidectomy is one of the important head and neck surgeries which is mostly performed due to complications of otitis media. This procedure is performed under microscopic surgery and as a result, a clean visual field is required for surgeons. Bleeding is one of the important issues during microscopic surgeries which reduces visualization. In this...
Citations
... However, the enlarged meatus has been identified a cosmetic problem. Regular care of the EAC with mastoid bowl was needed in prevention of water exposure and infection [99]. ...
... The silicone blocks, another kind of bioceramics, were flexible enough to handle and to fit into cavities of variable size, and rigid enough to prevent mastoid collapse. The usefulness of silicone blocks was evaluated as material for EAC obliteration in CWD patients by Cho et al. [99] (Fig. 7). Most patients receiving silicone blocks obliteration maintained good healing of reconstructed EAC. ...
Biomaterials play an integral role in treatment of external auditory canal (EAC) diseases. Regarding the special anatomic structure and physiological characteristics of EAC, careful selection of applicable biomaterials was essential step towards effective management of EAC conditions. The bioactive materials can provide reasonable biocompatibility, reduce risk of host pro-inflammatory response and immune rejection, and promote the healing process. In therapeutic procedure, biomaterials were employed for covering or packing the wound, protection of the damaged tissue, and maintaining of normal structures and functions of the EAC. Therefore, understanding and application of biomaterials was key to obtaining great rehabilitation in therapy of EAC diseases. In clinical practice, biomaterials were recognized as an important part in the treatment of different EAC diseases. The choice of biomaterials was distinct according to the requirements of various diseases. As a result, awareness of property regarding different biomaterials was fundamental for appropriate selection of therapeutic substances in different EAC diseases. In this review, we firstly introduced the characteristics of EAC structures and physiology, and EAC pathologies were summarized secondarily. From the viewpoint of biomaterials, the different materials applied to individual diseases were outlined in categories. Besides, the underlying future of therapeutic EAC biomaterials was discussed.
... Various techniques for canal wall reconstruction (CWR) and mastoid obliteration have evolved to minimise the challenges posed by a large mastoid cavity. Both biological (autologous grafts, allografts and xenografts) and synthetic (bioactive glass [1,2], hydroxyapatite and silicone [3]) materials have been employed for mastoid obliteration. ...
Background
While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative.
Methods
Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC.
Conclusions
The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.
... However, it is associated with infections, osteitis, delayed osseointegration and extrusion (about 15.8%) [16,17]. Silicone is a safe and low cost material that, however, can lead to foreign body reaction [18]. Titanium has been described as biocompatible and pliable [2]. ...
Purpose
To investigate safety and efficacy of mastoid obliteration in canal-wall-down tympanoplasty performed for cholesteatoma using bioactive glass (BAG). The authors routinely adopt CWD tympanoplasty in case of massive cholesteatoma or revision surgery, performing obliteration with BAG to reduce the mastoid cavity and related disadvantages. We assessed anatomical results, infection control and cholesteatoma recurrence in obliterative mastoidectomy using BAG.
Methods
The authors evaluated 66 patients treated with obliterative mastoidectomy using BAG during the period 2010–2021. 48.5% of the cases had first diagnosis of cholesteatoma, 48.5% had cholesteatoma recidivisms, and two patients underwent obliteration to improve clinical outcome. BAG granules were always moistened with venous blood to enhance their adhesion and reduce the risk of dispersion. Anatomical results were evaluated in otomicroscopy and infection control was assessed during follow-up visits. Periodical otomicroscopy was performed to check recurrent cholesteatoma. MRI-DWI was indicated only in case of clinical suspect of cholesteatoma.
Results
Authors followed 66 patients during a mean of 23 months. No post-operative wound infections occured. The mean re-epithelialization time was 45 days. At the last visit, control of infection was achieved in 97% of patients and a clinical stable anatomical cavity in all patients. No clinical suspect for recurrent cholesteatoma was found.
Conclusions
The use of bioactive glass is safe and effective as obliteration material in cholesteatoma surgery. Authors pay a particular attention to obliterate only patients without suspect of epithelial residual, to correctly calibrate the ear canal and to completely cover the granules with graft.
... Grafting materials used for tympanic membrane, mastoid and ear bones reconstructions are as follows: autologous (e.g. bone, cartilage, muscle, fat), heterologous (bio-hydroxyapatite from animal origin) or synthetic (synthetic hydroxyapatite, calcium phosphate ceramic, bone pâté and bioglass) [23][24][25]. Bioglass S53P4 (BG) is being used routinely in ear-nosethroat (ENT) surgery owing to its silicon composition thus reducing its contamination by keratin producing cells [26,27], its osteogenesis and antibacterial properties and its sustainability in time [28][29][30]. Natural bone substitute, bio-hydroxyapatite (BHA) of bovine origin is routinely used in orthopedic and dental surgeries [31]. ...
PurposeRadiological assessment of osseointegration of mastoid grafts: biological hydroxyapatite (Bio-Oss®) (BHA) versus bioglass S53P4 (Bonalive®) (BG).Methods
Retrospective (10 ± 4 months post-surgery) monocentric high resolution computed tomography (CT) scan assessment (November 2018 and October 2020) by two independent radiologists (R1, R2), blinded to patient allocation. All patients who had undergone a total mastoid obliteration were eligible. Excluded: complications namely otological acute or chronic infections, unbalanced metabolic disease, long-term cortico-steroid therapy, auto-immune disease, history of allergy to grafting materials and post-surgery CT scan in other centers (n = 8). Primary outcomes: the ratio between two regions of interests (ROI) (graft to otic capsule). Secondary outcomes: resorption of mastoid grafts and assessment of clinical tolerance.ResultsIncluded 21 patients (mean age: 29 ± 21 years; 5 females, 16 males). Significantly higher osseointegration for BHA vs. BG (R1 p = 0.043; R2 p = 0.004); almost perfect inter-reader agreement k = 0.922). The ROI ratios for BHA and BG to that of the otic capsule were 0.57 ± 0.11 (R1) and 0.59 ± 0.14 (R2); 0.43 ± 0.11 (R1) and 0.43 ± 0.08 (R2), respectively. Density increased significantly by 399 ± 261 Hounsfield units (HU) (p = 0.008) and decreased by 464 ± 161 HU (p < 0.001) for BHA vs. BG. Resorption rates were 24.1 ± 21.0% and 66.7 ± 15.1% (p = 0.076), respectively. No significant difference in clinical tolerance was observed.Conclusion
Post-operative CT scan of mastoid obliteration seems reliable in assessment of biomaterial graft’s mid-term feasibility and stability: BHA seems to provide a more optimal osseointegration versus BG with no significant differences in graft resorption and clinical tolerance.
... A középfülben lezajló gázcserefolyamatok jobb megértése [3], a szintetikus obliteráló anyagok -hidroxilapatit granulátum [8], bioaktív üvegkerámia (Ceravital ® ) [9], kétfázisú kalcium-foszfát kerámia [10], szilikonblokk [11] -megjelenése, valamint a diffúziósúlyozott MRI elterjedése az elmúlt évtizedben ismét felélénkítették az érdeklődést az obliterációk iránt [12]. A szintetikus anyagok és az általunk is kipróbált BonAlive ® granulátum előnye, hogy korlátlan mértékben rendelkezésre állnak, nincs donorhely-komplikáció, nem sorvadnak el vagy szívódnak fel az idő múlásával, szükség esetén könynyen cserélhetők, és ellenállnak az infekcióknak, illetve antibakteriális hatásuk is van [7,12,13]. ...
Introduction and objective:
Mastoid obliteration technique combines the advantages of canal wall-up (CWU) and canal wall-down (CWD) approaches in the surgery of chronic suppurative otitis media with cholesteatoma. We aim to demonstrate our experience with mastoid obliteration technique using bone dust and BonAlive® (S53P4) bioactive glass granule in a comparative prospective clinical study.
Patients and methods:
Between 1st of March 2012 and 31st of November 2021, mastoid obliteration surgery was performed in 14 patients using bone dust (7 cases) and BonAlive® granule (7 cases). Prior to these interventions, the patients had undergone more than three ear surgeries (CWU and CWD) generally in both groups. Changes of complaints, audiological results, and changes in quality of life were analysed in both groups, postoperatively.
Results:
Having performed the mastoid obliteration technique, cochlear damage did not occur in either patient group. Long-term ear discharge and vertigo were occasionally observed after performing obliteration with bone dust. However, these complaints disappeared after a while. Complications were not reported in the case of obliteration with BonAlive®. Outstanding improvement was experienced in both groups.
Conclusion:
In our practice, mastoid obliteration surgery, using either bone dust or BonAlive® granule, has proved to be a safe and effective method in the management of chronic suppurative otitis media with cholesteatoma, resulting in continuous putrid ear discharge after CWU or CWD tympanoplasty. Obliteration with BonAlive® granule provides several advantages for patients, such as antibacterial effect, osteoconductive effect ensuring frame for bone growth and osteoproductive effect stimulating the ossification. Orv Hetil. 2022; 163(21): 838-845.
... Reconstruction of the posterior canal wall after CWD surgery with or without obliteration of the mastoid seems to be a more appropriate solution combining low recidivism rate with a low ear discharge rate [10]. Several techniques of mastoid obliteration were suggested, using muscle flap [11,12], cortical bone pate [11,13], autogenous or allogenous bone chips [13,14], silicone [15], and hydroxyapatite [12,16]. ...
Background
This study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session. Sixty-three patients with cholesteatoma underwent the technique mentioned above; patients were followed for 1 year postoperative.
Results
No cavity problems, median preoperative air bone gap was 32.86 ± 6.24 db, while the median postoperative air bone gap was 21.67 ± 5.99 db.
Conclusions
Canal wall down mastoidectomy with obliteration of mastoid cavity is an effective option for the complete removal of cholesteatoma and same session cartilage ossiculoplasty is a viable option.
... 8 Examples of synthetic materials are hydroxyapatite, 9 bioactive glass material, 10 composite multifractured osteoplastic flap, 11 and silicone block. 12 To the best of our knowledge, only a study by Cho et al, 2012 attempted to use silicone block for the obliteration of the mastoid cavity. In the mentioned retrospective study, a combination of silicone block, bone pate, and muscle flap was used on 20 patients, of which 17 patients were suffering from chronic otitis media with cholesteatoma. ...
... 8 Examples of synthetic materials are hydroxyapatite, 9 bioactive glass material, 10 composite multifractured osteoplastic flap, 11 and silicone block. 12 To the best of our knowledge, only a study by Cho et al, 2012 attempted to use silicone block for the obliteration of the mastoid cavity. In the mentioned retrospective study, a combination of silicone block, bone pate, and muscle flap was used on 20 patients, of which 17 patients were suffering from chronic otitis media with cholesteatoma. ...
... In the mentioned retrospective study, a combination of silicone block, bone pate, and muscle flap was used on 20 patients, of which 17 patients were suffering from chronic otitis media with cholesteatoma. 12 Hence, we became intrigued to apply silicone blocks after reading the aforementioned article. The data on whether or not silicone block is beneficial for the obliteration of mastoid is still inadequate. ...
Objective
To prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used.
Methods
In this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome.
Results
The time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow‐ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported.
Conclusion
Silicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy.
Level of Evidence
4.
... [1][2][3][4][5] Mastoid reconstruction principle had been described to overcome these problems and different materials were used; these materials can be classified into: (1) free grafts (biologic and nonbiologic) and (2) local flaps. [4][5][6][7][8][9][10] All of these techniques have their advantages and disadvantages but nonbiologic materials seem to be less preferred. 1,2,6 Platelet-rich plasma (PRP) is a simple laboratory method to obtain a high concentrates of autologous growth factors. ...
... Autologous tissues (cartilage, cortical bone pate, and bone chips) were mentioned with good results. [1][2][3][4][5][6][7][8] The PRP in Otology Platelet-rich plasma has a high concentration of platelets and normal concentration of fibrinogen. The high concentration of platelets could promote wound healing and tissue sealing; thus, it had been used by otologists in TM perforation and good results were obtained. ...
Objectives
Mastoid reconstruction principle had been described to overcome problems of chronic discharging cavity. Different materials were used; nonbiologic materials seem to be less preferred. Platelet-rich plasma (PRP) could promote the regeneration of mineralized tissues. In this work, the authors present a simple and easy technique for mastoid reconstruction with PRP and cortical bone pate.
Methods
The study design is a case series. Patients had mastoid reconstruction after canal wall down mastoidectomy using PRP and cortical bone pate.
Results
This study included 21 patients: 9 males, and 12 females. Sixteen patients had left side disease. All surgical procedures were conducted smoothly within 90 to 135 minutes with no stressful events had been reported. At 12 to 16 months of follow-up, external canal stenosis and mastoid fistulas were not reported. Good healing of the tympanic membrane was seen in 18 patients. No radiological signs suggestive of recurrence were detected and the reconstructed mastoid cavity was smooth and well aerated. Residual tympanic membrane perforations were detected in 3 patients.
Conclusion
Autologous materials (PRP and bone pate pate) after canal wall down mastoidectomy appear to be a reliable and effective choice for mastoid reconstruction.
... Sono sotto forma di granuli di ceramica fosfocalcica che possono essere idrossiapatite [23,24] , ceramiche porose, MBCP (macroporus bifasico di calcio fosfato) [25,26] , blocchi di silicone [27] , vetro bioattivo [28] o impianti in titanio [29] . ...
Riassunto
L’otite cronica colesteatomatosa rappresenta un pericolo per il paziente a causa delle complicanze infettive, anatomiche e funzionali. Solo il trattamento chirurgico è efficace. Questo deve essere pianificato aiutandosi con una radiologia preoperatoria di qualità mediante tomografia computerizzata, la quale rende possibile valutare l’estensione del tumore, con l’analisi dei criteri anatomici, funzionali e relativi al paziente e con la scoperta di possibili complicanze. Gli obiettivi sono l’eradicazione della lesione, attuare una limitazione del rischio di colesteatoma residuo e di colesteatoma ricorrente, ottenere il miglior risultato funzionale per l’udito e consentire al paziente di avere una migliore qualità della vita. Le tecniche chirurgiche si sono evolute. Esse sono schematicamente divise in tecniche cosiddette chiuse, che sono conservative della struttura ossea del condotto uditivo esterno (CUE) (canal wall-up procedures degli anglosassoni), e in tecniche cosiddette aperte, che la sacrificano (canal wall-down procedures degli anglosassoni). Le tecniche di riempimento sono state descritte da molto tempo; possono riguardare l’attico, le cavità posteriori o entrambi ed essere eseguite durante una tecnica chiusa con o senza rimozione del CUE o durante una tecnica aperta. L’uso del microscopio operatorio è classico; si sta sviluppando quello delle ottiche, che consente il controllo delle zone scure, e, talvolta, degli accessi minimamente invasivi. Infine, alcuni colesteatomi estesi o intrapetrosi richiedono tecniche operatorie specifiche, che non sono discusse qui.
... 6 With canal wall down mastoidectomy there is excellent exposure for disease eradication and post operative monitoring; also there is less chance of leaving behind residual disease with low rates of recurrence. 7 But it is associated with patient's intolerance to water exposure; requirement of frequent cleaning of cavity; calorically and barometrically induced vertigo; aesthetic inconvenience due to too large meatoplasty; recurrent infection; difficulty in wearing traditional hearing aids. Also the final hearing gained after staged ossiculoplasties in patients who have undergone canal wall down mastoidectomy is usually 5-10dB worse than those who underwent canal wall up tympano-mastoidectomy due to ineffective sound transmission. ...
Introduction
Mastoid operations have been in practice for over four centuries for suppurative conditions of the ear. Intact canal wall mastoidectomy has the advantage of better functional results while canal wall down mastoidectomy offers excellent exposure for disease eradication and post operative monitoring but is associated with significant cavity problems. In order to overcome the problems associated with canal wall down procedure while retaining its advantages the concept of mastoid cavity obliteration was introduced. This study analysed the outcomes of mastoid cavity obliteration and to assess the outcomes of mastoid cavity obliteration with autologous adipose tissue.
Materials and Methods
A prospective, experimental, randomized study was conducted over a period of 18 months among patients presenting with active squamous variety of Chronic Otitis Media. The patients were randomly allocated to two groups, A and B. Both groups underwent canal wall down Mastoidectomy followed by obliteration with autologous adipose tissue in Group B .
Results
In group A, the mean duration required for complete epithelialization was 10.8 weeks. In group B, the average time taken for complete epithelialization was 5.6 weeks. All cases had their graft intact at the end of 12 weeks. Debris was present in group A for a mean duration of 9.47 weeks. In group B, debris was found for a mean duration of 3.33 weeks. Patients from group A complained of discharge from their ears for a mean duration of 7.47 weeks. In group B the same symptom persisted over 3.33 weeks.
Conclusion
Cavity problems encountered is considerably less in the group obliterated with adipose tissue.
