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Postoperative Middle Ear Aeration and Hearing Results after Canal Wall Down Tympanoplasty with Soft-Wall Reconstruction

Objectives: (1) Estimate the degree of postoperative aeration in the middle ear after canal wall down tympanoplasty with soft-wall reconstruction (CWD tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD tympanoplasty with SWR. Methods: This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy-eight ears with cholesteatoma treated surgically at our hospital by planned two-stage CWD tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second-stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air-bone (A-B) gaps: 0-10, 11-20, 21-30, and >30 dB. Results: Postoperative middle ear aeration was significantly greater in the smaller A-B gap bins (0-10 and 11-20 dB) compared with the larger A-B gap bins (21-30 and >30 dB). In contrast to the larger A-B gap bins, those with smaller A-B gaps showed reaeration of the antrum and mastoid cavity. Conclusions: Promoting postoperative aeration of the entire middle ear is necessary to achieve better hearing outcome in patients undergoing CWD tympanoplasty with SWR for cholesteatoma. The ventilation tube insertion and placement of the large silicone sheet from the protympanum to the mastoid cavity in the first-stage tympanoplasty are candidate procedures to promote postoperative aeration.