Professional Documents
Culture Documents
give the eardrum a chance to heal in a lateral position, so that when we go back and
do the ossiculoplasty, we dont have to worry about retraction of the tympanic
membrane.
AO/Beck: And finally, Dr. Leonetti, can you please speak about the indications for a
canal wall down procedure? My understanding of the canal wall down is that is the
most dramatic of the mastoidectomies, and that it removes the bony structure of the
ear canal via the drill, hence the name (canal wall down) and that does impact the
anatomical structure and the function of the ear canal, but the CWD is done primarily
to eradicate disease, rather than to preserve or restore hearing.
Leonetti: Yes. The indications for a canal wall down procedure would be a large
cholesteatoma involving the mastoid cavity, or, a patient with chronic otitis media
who has already failed a canal wall up procedure.
There is a category of canal wall down procedures based on intracranial complications
of chronic otitis media, due to cholesteatoma. For example brain abscess or
meningitis from ear disease, or even a sigmoid sinus thrombosis from ear disease,
these would merit a canal wall down procedure.
The final category well talk about for CWD procedures would be when you have
patients who are not likely to follow-up for the second procedure. Sometimes we
might do a modified radical right off the bat for patients who are indigent, perhaps
handicapped mentally or physically and not likely to be able to have a second
procedure, or people who are just not likely to follow-up. We know that if we give
them a CWD, or basically an open mastoid cavity, the cholesteatoma is not going to
reoccur and sometimes, based on the socioeconomic status, thats the safest way to
go for their benefit.
AO/Beck: What about long term maintenance for the CWD post-op care?
Leonetti: Thats a good point. For most patients with a CWD, theyll need to have a
physician clean the cavity once a year or so. If the CWD procedure heals well with no
problems, most of those patients can even go swimming if they so desire.
AO/Beck: And of course the caution there is that only the surgeon should clean out
the mastoid cavity and only the surgeon should make the determination about
swimming and related ongoing care issues.
Leonetti: Exactly right.
AO/Beck: OK, Dr. Leonetti, it has indeed been a pleasure to spend so much time
with you and to pick your brain on these issues. Perhaps we can do a follow-up next
year on a few more related topics?
Leonetti: That would be great Doug. Thanks to you too for your time and
preparation.
CLICK HERE TO REVIEW Part One Tympanoplasty
CLICK HERE TO REVIEW Part Two - Cholesteatoma