Outcome data
All cholesteatomas with LFs underwent canal wall down mastoidectomy and primary mastoid obliteration with local tissue flaps (middle temporal artery or inferior musculoperiosteal flaps). Middle ear reconstruction utilized cartilage placed onto remnant stapes suprastructure if present or stapes footplate if absent stapes. Surgeon 1 employed complete matrix removal in 86% (12/14) of LFs, by leaving the matrix and cholesteatoma over the SCC till the last stage of operation, before delicately removing the matrix. This was followed by immediate bone-wax sealing of fistula in 50% (6/12) and temporalis fascia in 8% (1/12). As the endosteum was intact in the remaining 5 cases, these cases were not sealed. Surgeon 2 performed matrix preservation in the remaining 14% (2/14) SCC fistulas. Revision mastoidectomies for recurrent cholesteatoma were required in 14% (2/14). These 2 cases had complete matrix removal, whereby time to recurrence was 5 years and 6 years respectively.
Postoperative hearing PTAs were taken at a mean of 2.1 years (1.5, 0.14-4.84). Mean preoperative and postoperative BC thresholds were 38.4dB and 45.3dB while AC thresholds were 73.6dB and 79.4dB respectively. 21.5% (3/14) ears had preoperative severe to profound sensorineural hearing loss. The remaining 11 ears were evaluated on their pre and postoperative hearing [Table 2]. Of the 11 ears, 9 ears had their matrix completely removed and LF repaired, and 2 ears had matrix preservation with a modified radical mastoidectomy performed as the fistula was large.
Matrix removal group had hearing levels with no change in 78% (7/9), improvement in 11.1% (1/12) and decreased in 11.1% (1/12). Mean preoperative and postoperative BC thresholds were 33.1dB (17.8, 13-68) and 38.8dB (19.3, 13-68) respectively. Postoperative hearing thresholds done within 120 days showed worsening hearing in 22% (2/9) ears, that subsequently had hearing restoration achieved at the last follow-up of 3.2 years and 1.6 years respectively.
The 2 LFs with matrix preservation had decreased hearing levels, after a follow-up time of 3.2 years and 2.7 years respectively. Increase in BC thresholds preoperatively to postoperatively were 30dB to 65dB over 2.7 years for patient 1 and 40dB to 72dB over 3.2 years for the other.