Mastoid Surgery Does Not Normalize Tympanometric Middle Ear Pressure in Children With Cholesteatoma

To determine whether transcanal surgery without mastoidectomy, canal wall up (CWU), canal wall down (CWD), or CWU mastoid obliteration (MO) surgery for pediatric cholesteatoma has a more favorable effect on middle ear pressure (MEP) homeostasis.

Data from children having mastoid surgery for acquired cholesteatoma were collected prospectively. Tympanometric values of MEP were compared after transcanal, CWU, CWD, and MO surgery analyzing (i) a single measure per ear from last clinic visit, and (ii) linear mixed-effects modeling (LMEM) to control for multiple measures, surgeries, age, and cholesteatoma severity (EAONO-JOS stage).

742 surgeries on 471 ears and 2382 tympanograms were completed. At last visit, (average age 15.6 years [6.0-19.3]), Type a tympanograms were present in 80/173 (46%) of transcanal surgeries, 64/132 (48%) CWU, 15/32 (47%) CWD, and 11/25 (44%) MO (Chi-square, p = 0.19), but 185/209 (89%) contralateral ears without cholesteatoma (Chi-square: p = 1.08 × 10^-7). Median MEP was -47 daPa (IQR: 133) after transcanal, -65 daPa (IQR: 156) after CWU, -90 daPa (IQR: 151) after CWD, and -31 daPa (IQR: 151) after MO surgery and (Kruskal-Wallis: p = 0.4) but 5 daPa (IQR: 45) in normal contralateral ears (Wilcoxon: p = 7.92 × 10^-13). LMEM showed MEP was dependent on age (p = 6.3 × 10^-7) but not type of mastoid surgery (p = 0.70) or EAONO-JOS stage (p = 0.51).

MEP after surgery for pediatric cholesteatoma is similar after transcanal, CWU, CWD, or MO surgery and remains lower than normal. Hypotheses that propose beneficial effects of these different surgical approaches on MEP homeostasis are not supported, so should not be used to influence choice of surgical approach.