Modified Bondy's technique: refinements of the surgical technique and long-term results

To evaluate the short- (6 mo) and long-term (5 yr) outcomes of modified Bondy technique, with particular reference to hearing results.

Retrospective study.

Quaternary referral otology and cranial base center.

Two hundred thirty ears of 222 patients were operated on, using a modified Bondy technique between 1983 and 2005. All patients had primary acquired epitympanic cholesteatomas with intact pars tensa and intact ossicular chain in normal or good-hearing ear. Preoperative audiometric results revealed a mean air conduction pure-tone average of 27.7 +/- 9.6 dB (range, 10-65 dB) and a mean bone conduction pure-tone average of 14.2 +/- 6.4 dB (range, 5-50 dB). The mean preoperative air-bone gap was 13.5 +/- 6.7 dB (range, 0-25 dB). The average length of follow-up was 7.8 years (range, 5-16 yr).

There was no recurrent cholesteatoma in the present series. A pearl-like residual cholesteatoma was found in the cavity in 7.4% of ears. Two patients (0.8%) developed stenosis of meatoplasty. Three ears (1.3%) exhibited retraction pockets extending to the attic. Postoperative discharging ear was observed in 3% of cases and was successfully treated with topical drops. At the long-term follow-up, the air-bone gap was unchanged or improved from the preoperative level in 88% of cases. The mean postoperative short- and long-term air-bone gaps were 14.6 +/- 8.5 dB (range, 0-55 dB) and 14.1 +/- 8.2 dB (range, 0-50 dB), respectively. Postoperative high-frequency sensorineural hearing loss with bone conduction worsening between 20 and 30 dB at 4 kHz was observed in 4 cases (1.7%). No dead ears were encountered postoperatively.

A modified Bondy operation is recommended in selected cases of epitympanic cholesteatoma in normal or good-hearing ear with an intact pars tensa and ossicular chain. Modified Bondy technique ensures complete eradication of disease while preserving a good preoperative hearing in 1-stage operation.