Revision Canal Wall Down Mastoidectomy with Mastoid Obliteration
C. Scott Brown, MD1; Prithwijit Roychowdhury2; Calhoun D. Cunningham III, MD1
1Duke University Medical Center
2University of Massachusetts Medical School
Revision canal wall down (CWD) mastoidectomy with mastoid obliteration is most often performed to manage persistent otorrhea and debris accumulation in the mastoid bowl following CWD mastoidectomy. In this case, obliteration is performed for persistent otorrhea from the mastoid bowl and revision CWD mastoidectomy is completed to address a new retraction pocket following a prior CWD mastoidectomy for chronic otitis media with cholesteatoma in a 23-year old male.
There have been numerous reported techniques used for mastoid obliteration, and in this case, a posterior periosteal flap is made, and the mastoid cavity is filled with autogenous bone paté. Following obliteration of the mastoid, a perichondrial graft is used to cover the area. In this case, a titanium total ossicular reconstruction prosthesis is used to rebuild the ossicular chain, and a second perichondrial graft is used to reconstruct the tympanic membrane. The canal is packed with Gelfoam to secure the fascial grafts in place. Postoperatively, patients are typically advised to remove their head dressing 24 hours following the surgery and to apply a topical antibiotic ointment daily to a cotton ball in the ear.
Mastoidectomy
David M. Kaylie, MD, MS1; Adam A. Karkoutli2; C. Scott Brown, MD1
1Duke University Medical Center
2Louisiana State University Health Sciences Center – New Orleans
Mastoidectomy involves the removal of bone and air cells contained within the mastoid portion of the temporal bone. Common indications for this procedure include acute mastoiditis, chronic mastoiditis, cholesteatoma, and the presence of tympanic retraction pockets. Mastoidectomy may also be performed as part of other otologic procedures (e.g. cochlear implantation, lateral skull base tumors, labyrinthectomy, etc.) in order to gain access to the middle ear cavity, petrous apex, and cerebellopontine angle.
The procedure involves dissecting within the confines of the mastoid cavity, which include the tegmen superiorly, the sigmoid sinus posteriorly, the bony ear canal anteriorly, and the labyrinth medially. Mastoidectomy is traditionally classified as: simple (cortical/Schwartze), radical, and modified radical/Bondy’s mastoidectomy. The procedure can also be classified based on the preservation of the posterior canal wall: canal wall up (CWU) or canal wall down (CWD).
Endolymphatic Sac Decompression
C. Scott Brown, MD; Calhoun D. Cunningham III, MD
Duke University Medical Center
Endolymphatic sac (ELS) decompression can be performed for patients with Meniere’s disease who have failed conservative treatment such as dietary changes and medical therapy. The full pathophysiological mechanisms that result in Meniere’s disease are not entirely understood. The variation in techniques for performing ELS decompression support this; there is no concrete data to justify one approach over another. Regardless, in the correct patient, ELS decompression can significantly alleviate the patient’s symptoms. To do so, a mastoidectomy is performed to expose the bony labyrinth as well as the bone overlying the sigmoid sinus. Decompression of the sac can be accomplished by removing overlying bone, incising the dura, or stenting the dura open.
Mastoidectomy
Duke University Medical Center
David M. Kaylie, MD, MS
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
Dr. David Kaylie performs a standard mastoidectomy, outlining the critical steps that are necessary for this workhorse procedure in otology.
Mastoid Obliteration
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
After a canal-wall-down mastoidectomy for cholesteatoma, a patient presented with recurrence and persistent infection. Dr. Calhoun Cunningham III performs a mastoid obliteration with ossicular chain reconstruction to both eradicate the disease and restore the patient's hearing.
Endolymphatic Sac Decompression
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
A patient with intractable Meniere’s disease presents for decompression of the endolymphatic sac. Dr. Calhoun Cunningham demonstrates the anatomical boundaries of the sac and explains his approach of stenting the sac open in order to alleviate the patient’s symptoms.
Cochlear Implant
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
Dr. Cunningham demonstrates the round window approach for placement of an Advanced Bionics Cochlear Implant into the right ear of a patient with severe to profound sensorineural hearing loss. Emphasis on surgical anatomy and technique is emphasized as he performs this delicate neurotological procedure.
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