Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy.

BACKGROUND: Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW).

OBJECTIVES: To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using bioactive glass (BAG) that is fabricated and built up intraoperatively.

PATIENTS AND METHODS: This study was applied on 20 patients had atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively.

RESULTS: During a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006).

CONCLUSION: Surgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.