Rehabilitation of the Tympanomastoid Cavity in Canal Wall Down Procedures

During 1980 to 2004, 1602 Canal Wall Down (CWD) procedures was performed of which 978 had primary surgery and 624 were revision cases. We have highlighted various methods for total clearance of disease process from the tympanomastoid area, making of a smooth cavity, augmentation of middle ear space for better functional results, inlay temporalis fascia grafting, ossiculoplasty with live tissue grafts, natural obliteration of the cavity and meatoplasty.Healing of cavity and tympanic membrane (TM) graft was achieved in 1548 (94.2%) of cases. Revision surgery was performed in 32 cases for recurrence or residual cholesteatoma, mostly in the attic and middle ear. Persisting discharge was present in 12 cases. Serviceable hearing (airbone (A-B) gap closure up to 20 dB) was achieved in 1017 (63.5%) cases. Hearing was worse than pre-operative level in 154 (9.6%) cases. There was no improvement in hearing in 397 (24.8%) cases. Serviceable hearing was obtained after second stage ossiculoplasty in 34 (2%) cases.