Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery

Hearing results were studied in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery in a private practice setting. A retrospective chart review was performed on 69 patients who underwent surgery from 1991-1995. Twenty-six patients underwent canal-wall-up mastoidectomies, and 43 patients underwent canal-wall-down mastoidectomies. Various types of ossicular reconstruction were performed in patients in both groups. Hearing was evaluated for preoperative and postoperative pure-tone averages, speech-reception thresholds, and air-bone gaps for the various types of ossicular reconstruction. Patients with canal-wall-up mastoidectomies and an intact ossicular chain had an average postoperative air-bone gap of 15 dB, whereas reconstruction of the ossicular chain (regardless of technique) resulted in an average postoperative air-bone gap of 19 dB. Patients with canal-wall-down mastoidectomies and an intact ossicular chain had an average air-bone gap of 15 dB, while all techniques of ossicular reconstruction had an average air-bone gap of 29 dB. Canal-wall-up and canal-wall-down mastoid surgeries in pediatric patients have similar hearing results. Variables other than hearing should be used to make treatment decisions regarding the canal wall in pediatric candidates for mastoid surgery.