Removal of cholesteatoma via combined approach Tympanoplasty
Combined approach tympanoplasty (CAT) or canal wall up (CWU) mastoidectomy is a surgical procedure performed for the removal of a cholesteatoma in which the wall of the ear canal is left intact.
Cholesteatoma is an abnormal growth of skin in the middle ear behind the eardrum. Layers of old skin build up inside the ear to form a pouch which overtime increases in size and damages the ossicles of the middle ear. The ossicles refer to the tiny bones which transmit and amplify external sound to the inner ear. Enlargement of this pouch may cause pressure or a feeling of fullness in the ear. You may experience symptoms such as foul smelling discharge, impaired hearing, and rarely, facial muscle weakness or paralysis.
CAT is most often indicated in children for removal of a cholesteatoma and to overcome long-term complications from the mastoid cavity.
The aim of this procedure is to remove the cholesteatoma, prevent future complications and spread of infection to other structures, and to leave the canal wall intact.
Combined approach tympanoplasty involves removal of the mastoid air-cells while retaining the bony walls of the ear canal intact. Surgery is performed under the effect of general anesthesia or local anesthesia with sedation. The operative steps include:
- A C-shaped hairline cut is made from above the pinna of the ear and a complete flap of skin from the mastoid bone is elevated.
- Your surgeon carries out a mastoidectomy (removing the mastoid air-cells in the skull behind the ear) to expose the ossicles of middle ear. A tympanotomy (incision into the eardrum) is performed to identify the facial nerve and prevent it from damage.
- Cholesteatoma with or without the damaged middle ear ossicles are removed based on the extent of injury present.
- Your surgeon will examine the cavity endoscopically (flexible tube attached to a video camera and lighted device) and check for any residual cholesteatoma.
- The bony canal wall is then reconstructed with bone graft or cartilage.
- The tympanic membrane is repaired (tympanoplasty) with a graft. Your doctor will pack the middle ear and external ear with gel foam to support the grafts. The incised whole skin flap is closed and sutured.
A second look procedure may be required after 9 to 12 months to evaluate for residual or recurrent cholesteatoma and for repair of the ossicular chain if needed.
Following the surgery, the operated ear and incision area should be kept clean and dry. Do not disturb the internal packing of the ear; you may trim the loose end of packing or change the external cotton wool packing if it gets soiled. The internal packing will be removed during your follow-up visit. Your surgeon may prescribe medications or ear drops to relieve pain and prevent infection. Avoid swimming, blowing the nose hard or strenuous exercises for a few weeks.
Risks and Complications
As with any surgery, modified radical mastoidectomy involves certain risks and complications. They include:
- Dizziness and ringing in ears (tinnitus)
- Loss of hearing
- Partial or complete facial nerve paralysis
- Taste alterations
- Ear infections