Ear canal reconstruction in mastoid obliteration surgery for cholesteatoma or radical cavity: a review of the literature

PURPOSE: There is no gold standard for canal wall reconstruction following its removal in mastoid obliteration surgery. This review aims to provide insight into the current state of the art on canal wall reconstruction, highlighting both successes and ongoing issues.

METHODS: Literature review (PubMed, Embase) of recent (≤ 15 years) articles describing mastoid obliteration surgery with canal wall reconstruction in cholesteatoma or radical cavity patients. The data extracted were the reconstruction techniques and surgical outcomes as procedure safety, cholesteatoma recurrence, postoperative complications of the canal wall, infection, otorrhea recurrence and hearing rehabilitation.

RESULTS: From 1584 articles, 28 were selected, 19 addressing cholesteatoma and 9 radical cavities. The most reported techniques were temporary removal and replacement of the canal wall and reconstruction using bone chips or cartilage. Perioperative complications were infrequent. Cholesteatoma recurrence ranged from 0-29%, infection from 0-27%, and otorrhea recurrence from 0-29%. The presence of postoperative complications or deformities of the canal wall were reported in the majority of included studies, indicating variable success. Hearing outcomes were generally positive. Considerable heterogeneity and inconsistent reporting limited reliable comparison of techniques between the studies.

CONCLUSION: This is the first review to specifically concentrate on ear canal reconstruction in mastoid obliteration. Despite generally successful outcomes, clinicians are still often faced with cholesteatoma recidivism and postoperative complications. The actual impact of the canal wall reconstruction technique on long-term outcomes remains unclear. More consistent reporting and prospective comparative research is needed to better understand the factors influencing success and improve care for cholesteatoma patients.