Hearing outcomes in canal wall up versus canal wall down mastoidectomy

Abstract Introduction: Chronic suppurative otitis media (CSOM) is a common problem seen in numerous patients with high rate of morbidity and psychosocial impact. The mainstay of management remains surgical. The two surgical techniques used globally for management of patients with middle ear cleft pathology are canal wall up and canal wall down mastoid surgeries. Deciding factors for type of procedure done depend on; the interest of operating surgeon, patient’s general health and age, extent and type of pathology in the middle ear and also considering functional hearing outcomes of both the surgical procedures. Objective The aim of the present study was to compare the hearing outcomes and graft take up rate between canal wall up and canal wall down mastoidectomy procedures. Methods The present prospective study was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, a tertiary care multi-speciality teaching hospital from October 2018- August 2020. The study group included 100 patients. In this study, all the patients underwent mastoidectomy with tympanoplasty using temporalis fascia graft. Intact canal wall mastoidectomy was done in patients with localized cholesteatoma while canal wall down mastoidectomy was done in patients having extensive disease. Regular follow up was done every week for first 3 weeks, later at 6th week, 3rd month, 6th month and 1 year. Study Design: Comparative study. Results A total of 100 patients were included in the study. The age of the patients 10 to 50 years with a mean age of 18.7 ± 15 years with male to female ratio 7:10. In the present study, graft take up in canal wall up mastoidectomy was 66.6% as compared to 33.4% in canal wall down procedure which was significantly higher (ꭓ2=10.72, p = 0.0011). Hearing gain in canal wall up procedure (17.02 ± 8.51db) was higher as compared to canal wall down mastoidectomy (10.3 ± 6.98), (t = 4.22, p < 0.001). It was statistically significant. Recurrence was seen in 1 patient who had undergone canal wall up surgery. Conclusions Canal wall down surgery is a safer option in the matter of residual disease and recurrence. Canal wall up surgery though may need a second look procedure, but there are better results of graft take up rate and the post-operative hearing as compared to canal wall down surgery