Curative effect of cholesteatoma by canal wall-down mastoidectomy and type IIIa tympanoplasty

Objective:To explore the curative effect and auditory outcomes in canal wall-down mastoidectomy and type Ⅲa tympanoplasty.Methods:Retrospective review of 62 patients with cholesteatoma,who underwent canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in a single stage.The postoperative complication,operation and aural rehabilitation were analyzed during 2-4 years follow-up.Results: In all 62 cases,3 patients remained tympanic perforation,6 patients with postoperative retraction pocket,1 reurrence of cholesteatoma and 3(3/62,4.8%)extrusion of ossicular replacement prosthesis.The rate of total curative effectiveness was 58.1%,dry ear was 91.9%,postoperative infection rate was 8.1%.Auditory outcomes showed that preoperative average air threshold(500,1 k,2 k,4 k Hz) was(51.0±13.5)dB,postoperative(32.6±8.8)dB,and average air threshold reduction was statistically significant(t=16.549,P0.01).Preoperative average air-bone gap was(35.2±10.0)dB,postoperative was(24.4±7.7) dB,with statistical significance(t=11.276,P0.01).Conclusion: Canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in single stage is safe and effective surgery for cholesteatoma,with less complication and relatively satisfactory hearing improvement.Application of tragal cartilage-perichondria autograft is of unique advantages.