Rehabilitation of Canal Wall Down Mastoidectomy Using a Titanium Ear Canal Implant

Objective: To describe the rehabilitation of canal wall down mastoidectomy cavities using a custom-made titanium wall implant and to analyze the benefits and the long-term functional results. Study Design: Retrospective analysis. Setting: Tertiary care center. Patients and Methods: We have reviewed the data of 113 consecutive operated ears from 106 patients during a 9-year period (1993-2002). The following preoperative and postoperative criteria were compared: the persistence or resolution of otorrhea, cholesteatoma, and vertigo; external auditory canal healing, position of the titanium prosthesis, and tympanic membrane findings. In addition, the hearing status was evaluated by comparing the preoperative data with the 6-month and last follow-up postoperative data to deduce the air-bone gap (ABG) and the auditory gains. Results: Operated ears (88.5%) were dry after the initial rehabilitation, and 97.3% were dry after a revision surgery for defective canal healing. Most patients (96.5%) were free of vertigo. The external auditory canal wall was in a good position in all cases and allowed for a primary skin healing process in 84% of cases; the remaining patients underwent revision surgery under local anesthesia to complete the healing. The reconstructed drum was stable and anatomic in 73% of the cases (n = 83) after the first surgery. Thirty-six patients (32%) underwent various revision procedures: aeration tube placement for 16 patients with mesotympanic retraction and/or serous effusion, revision surgery for 12 patients with attic retraction or evidence of cholesteatoma, and revision for 5 patients with perforation. At last follow-up, 100% of the ear canals were healed, and 85% of patients had a normal tympanic membrane. No residual cholesteatoma was found at last follow-up. Thirty-six percent of patients had an ABG within 20 dB at last follow-up, and 69% within 30 dB. Conclusion: The rehabilitation of canal wall down mastoidectomies improves the quality of life of patients regarding cholesteatoma recurrence, otorrhea, and vertigo in more than 95% of cases and stabilizes the hearing loss to less than 30 dB of ABG for more than two thirds of patients. The main unresolved problem is the persistent dysfunction of the middle ear cavity, with unsatisfactory auditory improvements. Middle ear implants represent in selected cases a new solution to rehabilitate the refractory hearing losses.