Surgical treatment of chronic middle ear disease. II. Canal wall up and canal wall down procedures.

Results of canal wall up (CWU) and canal wall down (CWD) tympanomastoid one-stage surgery were evaluated in 268 ears. In the CWU group of 121 ears, 50 ears (41%) had clinical cholesteatoma, whereas cholesteatoma was present in all 147 ears operated upon by the CWD technique. The disease was much less severe in the former group, which, for instance, showed no labyrith fistula, as compared with 17 (12%) in the latter group. Extensive disease also accounts for the larger number of complications seen in the CWD group. Average hearing levels postoperatively in the CWU group were significantly better than preoperatively. In the CWD group the preoperative levels were maintained. Recurrence of cholesteatoma was noted in 2% in the CWD group, while one implantation cholesteatoma occurred in the CWU group. Of the many surgical procedures available, the one offering the best means of curing the disease should of course be chosen. Ossicular repair with bone offers good prospects of a successful one-stage reconstruction.