Mastoid Obliteration with Concha Cartilage Graft and Temporal Muscle Fascia

Aim: The aim of our study was to describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and to review its efficacy in producing a dry, low-maintenance, small mastoid cavity. Material and Method: A retrospective clinical study of 56 consecutive patients undergoing procedures for active chronic otitis media with cholesteatoma has been carried out. All surgical interventions involved partial mastoid obliteration and restoration of the middle ear space by use of cartilage reconstruction of the tympanic membrane. Ossicular reconstruction was achieved with either a partial or total ossicular replacement prosthesis. Results: A completely dry cavity was achieved in 49 of 56 patients (approx. 88%, 95% confidence interval 77-95%). An overall statistically significant improvement in hearing (p < 0.05) was obtained, with the mean pure-tone average air-bone gap decreasing from 33.4 +/- 8.2 dB (average +/- SD) to 18.3 +/- 9.7 dB. There were no residual or recurrent cholesteatomas. Conclusion: Cartilage reconstruction of the tympanic membrane proved to be a useful adjunct in the surgical management of the chronically draining cavity. Copyright (c) 2012 S. Karger AG, Basel