The combination of two-cavity surgery, endoscopic control and obliteration of the mastoid with bioactive glass for primary operation of extensive Cholesteatoma

Cholesteatoma surgery is associated with a not insignificant number of recurrences. The standard is the complete removal of the cholesteatoma under a microscope using a closed or open technique. An alternative is the two-cavitiy procedure, in which the mastoid part of the cholesteatoma is removed transcortically and the tympanic part is removed transmeatally. The problem here is the inner bone edge of the posterior wall of the auditory canal, which cannot be reliably checked microscopically and has so far led to a high number of recurrences. The introduction of endoscopic technology in otology and obliteration materials such as bioactive glass (S53P4) can compensate for the specific disadvantages of the two-cavity procedure. This was checked as part of a retrospective study of the correspondingly operated patients. Between 01/19 and 10/23, a total of 95 patients with extensive cholesteatomas were operated on in the above-mentioned manner. The follow-up period was 12 months or longer in 73 patients. During this period, no recurrences were observed in the mastoid area, and the healing was significantly less problematic than would otherwise be expected from extensive ear operations. In two patients, a recurrent cholestatoma was only detected in the area of the tympanic ear and was then removed during a further operation. Postoperative hearing was within the range of data collected during comparable operations. By expanding the two-cavity procedure to include endoscopic control and obliteration of the mastoid cavity, the main disadvantages of this procedure can be eliminated.