Canal wall down with obliteration of cavity for paediatric cholesteatoma
Reviewed by Anand Kasbekar

The authors present evidence that canal wall down (CWD) surgery with primary obliteration is an effective way to treat paediatric cholesteatoma. Fifty-eight ears were operated on and follow-up was for five years on average. Residual cholesteatoma rate was 9.9% with no recurrences. Otorrhoea rate at one year was 0%. Reoperation risk was 17% at five years which included reasons such as hearing improvement (ossiculoplasty), planned second look and abnormality on the post-op CT scan at one year. The points to note are that firstly all children routinely require a CT scan post-op if they are compliant. This does not feel right, in view of the not so insignificant added risk of second malignancy in children exposed to CT scans. Perhaps this will change as the author’s institution has started diffusion weighted MR imaging. When performing this surgery, one has to be sure (as can be), that all cholesteatoma has been removed and all mastoid air cells are exenterated. The cavity is obliterated using cartilage plates and hydroxyapatite granules or glass-ceramic crystals. Follow-up for longer than 10 years may find extrusion of the exogenous material, although at the present time it is an attractive material to use. Good hearing results are also presented. Overall, the technique achieves with good probability the goal of leaving a trouble free, water-proof ear in children with often aggressive cholesteatoma and significantly reduces the need for automatic second-look surgery as in canal wall up surgery.

Paediatric cholesteatoma surgery using a single-staged canal wall down approach: results of a 5-year longitudinal study.
Trinidade A, Skingsley A, Yung MW.
OTOLOGY AND NEUROTOLOGY
2015;36(1):82-5.