Int. Adv. Otol. 2010; 6(2); 121-140

Transposed canal wall tympanomastoidectomy.
Tuncay Ulug
Istanbul University,Istanbul Medical Faculty, Istanbul, Turkey. ulugt@ttmail.com

Objective: The study was designed to describe and evaluate the technique of transposed canal wall (TCW) tympanomastoidectomy in the treatment of chronic otitis media with choleasteatoma.

Materials and Methods: Study design is prospective clinical study of randomly choosen 11 procedures performed from 2005 to 2008. Setting is tertiary referral center and academic practice in otology. The study population comprised of 7 males and 4 females, with an age range of 12-66 years. The interventions were based on enlarging the external auditory canal extensively and exenteration of the anterior part of the tympanomastoid with an outside-in technique, so that a new canal was created with a superior wall at the middle cranial fossa dural plate and the other walls transposed 2-3 mm posteriorly, inferiorly and anteriorly.
Depending on the extension of the cholesteatoma, a separated posterior mastoidectomy was added, protecting the transposed posterior canal wall. Main outcome measures were clinical follow-up and audiological assesment.

Results: Eight patients received a TCW anterior tympanomastoidectomy and 3 patients received a TCW anterior tympanomastoidectomy combined with posterior mastoidectomy. All of the 11 ears maintained a small anterior tympanomastoidectomy cavity. There was no residual or recurrent cholesteotoma, tympanic membrane perforation, perminent otorrhea or meatal stenosis. The mean air-bone gap was found 30.18 dB HL preoperatively and 20.09 dB HL postoperatively.

Conclusion: TCW technique provides improved intraoperative exposure of the key areas without creating a mastoid bowl, reduces the incidence of recidivism, and allows for hearing restoration by only transposing the canal walls circumferentially.