Tympanoplasty with mastoidectomy: canal wall up procedures

Management of the mastoid in cases of chronic otitis media with cholesteatoma remains controversial. Whether to leave the canal wall up or perform a cavity technique continues to be debated. The author reviewed his personal cases of surgery for chronic otitis media over a 5-year period and studied 108 cases without prior surgery who required tympanoplasty with mastoidectomy for cholesteatoma. Thirty-two percent of the cases were in children 15 years of age and under. Over two thirds of the procedures were canal wall up, and the remainder of patients underwent a canal wall down technique with obliteration. There was little difference in the results between children and adults, with the exception of there being a tendency for a greater degree of ossicular destruction in the children and a greater incidence of residual disease at second stage surgery. There was a 3 percent incidence of recurrent cholesteatoma. It appears that the intact canal wall technique is preferable in both children and adults, when circumstances are favorable.