Evaluation of the effectiveness of bone obliteration in cholesteatoma surgery

The main objective of this study was to compare the residual and recurrence rates in canal wall up, canal wall down, and canal wall down with reconstruction tympanoplasty for the treatment of cholesteatoma, considering the different filling materials used: no mastoid obliteration versus obliteration using Bone Pate versus obliteration using G45S5 (Glassbone^®).

This was a retrospective cohort study conducted at a single tertiary medical center. Patient who underwent canal wall up, canal wall down or canal wall down with reconstruction tympanoplasty for a cholesteatoma (primary, secondary, recurrent or residual), with or without mastoid obliteration, with Bone Pate or G45S5 between January 2007 and March 2023 were included. Patients with congenital cholesteatoma and with a follow-up less than 6 months or with any other type of surgery techniques were excluded.

A hundred and eight (46%) surgeries were performed without any mastoid obliteration, 66 (28%) with Bone Pate obliteration and 62 (26%) with G45S5 obliteration with a total of 236 surgeries. Survival analysis revealed significantly better outcomes for the Bone Pate cohort compared to without obliteration cohort on the recurrence and recidivism rate (HR 0.26; p = 0.03 and HR 0.39; p = 0.01 respectively). However, none of the statistical analyses showed significant differences between the non-obliteration cohort and the G45S5 cohort.

Our study highlights the benefits of Bone Pate obliteration in cholesteatoma surgery. However, it does not provide conclusive evidence on the effectiveness of G45S5 obliteration in preventing residual and recurrent cholesteatoma.