Reconstruction of radical mastoidectomy by obliteration technique

Reconstruction of radical mastoidectomy was performed by obliteration tympanoplasty using Palva flap in 199 ears either in one stage (normal mucosa, normal stapes, no risk of residual cholesteatoma behind the flap) or in two stages. At the 2nd stage, middle ear was reopened and the posterior cavity was checked in 34 cases. Bony pâté or ceramic granules may be added behind the flap, especially at this second stage. The closure of the tympanic membrane was achieved in 97% of cases. Residual cholesteatoma was removed in the middle ear at the 2nd stage in 17% of the ears. Late residual cholesteatoma behind the flap appeared in 5 cases where the posterior cavity had not been checked. Three early retraction pockets were due to technical failures which were more recently corrected by the use of fibromuscular graft placed between the fascia graft an the Palva flap. Three late retraction pockets progressed under the tympanic membrane from above to below. Hearing results were better in the 1st stage procedures, obviously selected: ABG within 20 dB in 83% of the ears with a normal stapes. On the contrary, in 2 stage procedures, ABG within 20 dB was achieved only in 50% of cases with a normal stapes and 29% of the ears where the crura were missing.