Canal Wall Down Timpanoplasty with Partial Mastoid Obliteration in Children and Adults Affected by Chronic Otitis Media with Cholesteatoma

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Abstract
Background: The aim of the study is to evaluate the incidence of recurrence of acquired cholesteatoma and functional outcomes in patients who underwent CWD tympanoplasty with cavity obliteration using an inferior-based musculoperiosteal flap. A comparison between children and adults was conducted. Methods: All surgeries performed by the same expert surgeon from 2016 to 2019 were considered for the study. Patients younger than 18 years old, operated on at Meyer’s Children Hospital, formed group A. Patients older than eighteen, operated on at Santo Stefano Hospital, formed group B. Clinical, audiological, and radiological data were collected from medical records. The Air Bone Gap (ABG) was used to assess the audiological results, and outpatient evaluations were considered to detect cases of recurrence. Results: Group A and Group B are composed of 23 and 25 patients, respectively. The postoperative ABG is 30.7 dBHL in group A and 29.5 dBHL in group B. The rate of recurrence is 17.2% in children and 8% in adults. The recurrence of cholesteatoma occurred in five children (21.8%) after an average follow-up of 18 months and in three adults (12%) after an average follow-up of 24 months. Conclusion: The surgical approach to CCOM in children aims to be as conservative as possible. The greater extension of the pathology is correlated with a greater erosion of the ossicular chain. According to our experience, open tympanoplasty with the obliterative technique allows us to obtain good anatomical and audiological outcomes, both in adults and children.

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