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Updated: May 20, 2026
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Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Patterns of failure in canal wall down mastoidectomy cavity instability
Michael B Gluth1, Aaron M Metrailer, John L Dornhoffer
1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. mbgluth@uams.edu
Summary
Revision surgery for canal wall down mastoid cavities often fails due to primary pathology and suboptimal cavity shape. These factors, including cholesteatoma and high facial ridges, are crucial for surgical success.
Area of Science:
- Otolaryngology
- Neurosurgery
- Surgical Pathology
Background:
- Canal wall down mastoidectomy creates an open cavity, which can lead to revision surgery due to instability.
- Understanding failure patterns is essential for improving surgical outcomes.
Purpose of the Study:
- To evaluate the failure patterns in patients requiring revision surgery for canal wall down mastoid cavities.
- To identify risk factors associated with unstable mastoid cavities.
Main Methods:
- Retrospective review of 130 adult and pediatric cases undergoing revision surgery for unstable open mastoid cavities (1995-2010).
- Analysis of demographic data, tympanomastoid pathology, and risk factors.
- Computed tomography (CT) scan review for cavity shape and size.
- Spearman's correlation analysis to identify associations.
Main Results:
- Common findings included stapes erosion (49.2%), cholesteatoma (44.6%), and tympanic membrane perforation (34.6%).
- Suboptimal cavity shape, such as a high facial ridge (54.2%), was frequently observed.
- Significant correlations noted between facial ridge height and tympanic membrane perforation with absent malleus.
Conclusions:
- While primary tympanomastoid pathology is frequent, suboptimal mastoid cavity dimensions are pervasive.
- Surgeons' approaches to the facial ridge and the association between absent malleus and tympanic membrane perforation were highlighted.
