ABSTRACT

Purpose. To evaluate the results of obliteration of paratympanic spaces with bone chips in patients with chronic tympanic otitis media.

Materials and methods. Surgical treatment was performed in 58 patients with chronic tympanic otitis media and cholesteatoma with a sclerotic type of mastoid process structure. Anatomical and functional results were evaluated according to the following criteria: good result — absence of cholesteatoma, complete solvency of the neotympanic membrane, improved hearing, preservation of the volume of bone chips according to MSCT of the temporal bones within 85-100%; satisfactory result — preservation of the volume of bone chips according to MSCT of the temporal bones within 85-100%, absence of cholesteatoma, need for reoperation due to lack of hearing improvement due to the presence of cicatricial changes in the tympanic cavity or neotympanic membrane, dislocation of the prosthesis, presence of retraction pockets; unsatisfactory result — if the above criteria are not met.

Results. Good results were achieved in 65.5% (38 patients) of the cases, satisfactory results were in 19.5% (11 patients), unsatisfactory results were detected in 15% (9 patients).Among patients with satisfactory results, 11 revision interventions were performed due to the development adhesive process in the tympanic cavity in 4 cases, dislocation of the prosthesis in 3 cases, retraction pocket in the neotympanic membrane in 2 cases. The reason for unsatisfactory results was the presence of one or more signs: 3 cases of cholesteatoma recurrence, 2 cases of formation of partial fibrous atresia of the external auditory canal, 3 cases of cicatricial adhesive process in the tympanic cavity. In all 9 cases the amount of bone-plastic material was less than 85% and the formation of retraction pockets was noted. According to audiometry data after 1 year, out of 38 patients with a good result, 20 patients (53%) had an air-bone interval of 0–10 dB, 16 (42%) had it of 10–20 dB, and 2 patients (5%) had it of 20–30 dB. 49 patients with good and satisfactory results according to MSCT of the temporal bones showed complete obliteration of the postoperative cavity.

Conclusion. The technique of using bone chips to obliterate paratympanic spaces in the surgical treatment of chronic otitis media with cholesteatoma has shown high efficiency in the sclerotic type of mastoid process structure, and allows achieving a stable anatomical result in 85% of cases during the primary operation and avoiding the formation of a radical cavity.

ABOUT AUTHOR

LITERATURE

1. Brown J.S. A ten-year statistical follow-up of 1142 consecutive cases of cholesteatoma: the closed vs. the open technique / J.S. Brown // Laryngoscope. — 1982. — Vol. 92, № 4. — P. 390–396. — DOI: 10.1288/00005537-198204000-00007
2. Geng H. Open cavity mastoidectomy improves audiological outcomes for cholesteatomatous chronic otitis media patients compared to closed cavity mastoidectomy / H. Geng, L. Han, Y. Tian [et al.] // Am. J. Transl. Res. — 2025. — Vol. 17, № 1. — P. 308–319. — DOI: 10.62347/DPOF4232
3. Ten Tije F.A. Postoperative Patient Reported Outcomes After Cholesteatoma Surgery / F.A. Ten Tije, R.J. Pauw, S.J.H. Bom [et al.] // Otol. Neurotol. — 2022. — Vol. 43, № 5. — P. e582–e589. — DOI: 10.1097/MAO.0000000000003509
4. Akula S. Surgical Efficacy of Mastoidectomy in Chronic Otitis Media: Squamosal Type / S. Akula, L.S. Reddy, T.M. Rani [et al.] // Indian J. Otolaryngol. Head Neck Surg. — 2023. — Vol. 75, Suppl. 1. — P. 250–254. — DOI: 10.1007/s12070-022-03386-6
5. Gantz B.J. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration / B.J. Gantz, E.P. Wilkinson, M.R. Hansen // Laryngoscope. — 2005. — Vol. 115, № 10. — P. 1734–1740. — DOI: 10.1097/01.MLG.0000187572.99335.cc
6. Сайдулаев В.А. Мастоидопластика при повторных санирующих операциях на ухе / В.А. Сайдулаев, А.С. Юнусов, И.Т. Мухамедов // Вестник оториноларингологии. — 2016. — Т. 81, № 1. — С. 40–43. — DOI: 10.17116/otorino201681140-43
7. Пчеленок Е.В. Результаты хирургического лечения хронического среднего отита с холестеатомой / Е.В. Пчеленок, С.Я. Косяков, А.В. Гуненков // Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. — 2019. — Т. 25, № 1. — С. 84–92. — DOI: 10.33848/foliorl23103825-2019-25-1-84-92
8. Waegeningh H.F. The bony obliteration tympanoplasty in cholesteatoma: safety, hygiene and hearing outcome: allograft versus autograft tympanic membrane reconstruction / H.F. Waegeningh, J.J.S. Dinther, R. Vanspauwen [et al.] // Eur. Arch. Otorhinolaryngol. — 2021. — Vol. 278, № 6. — P. 1805–1813. — DOI: 10.1007/s00405-020-06258-3
9. Lee W.S. Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket / W.S. Lee, J.Y. Choi
10. Baek M.K. Efficacy of Posterior Canal Wall Reconstruction Using Autologous Auricular Cartilage and Bone Pâté in Chronic Otitis Media with Cholesteatoma / M.K. Baek, S.H. Choi, D.Y. Kim [et al.] // J. Int. Adv. Otol. — 2016. — Vol. 12, № 3. — P. 247–251. — DOI: 10.5152/iao.2016.2076