Page 66 - Revista Portuguesa - SPORL - Vol 63. Nº2

to CWU techniques in order to not create an as innumerous other factors may have a more
open cavity which could significantly affect prominent role in that respect, such as the
the quality of life of patients. Additionally, for state of the ossicular chain and the different
CWU procedures we did not feel the need types of ossicular reconstructions performed.
to perform a routine second-look surgery as Regarding recidivism, these cases were
the imaging techniques available for follow- significantly lower in the CWD group. Our
up, namely diffusion weighted magnetic results are in line with many convincing
resonance imaging, have proven to be both publications which showed that a wall down
sensitive and specific for detecting recidivism, technique is the safest choice to prevent the
and, therefore, are reasonable alternatives. 13,14 need for a second surgery 4,20-22 . The most
The decision-making process for the surgical likely explanation for this is that relapses may
technique was made preoperatively in some originate from residual epidermic tissue left in
instances including relapses (which were all difficult access sites for a wall up approach. In
managed with CWD techniques). However, that regard it is interesting to note that in 42,9
in most cases, it was made intraoperatively % of our relapses there was cholesteatoma
considering anatomic factors, extension of the visible in the supratubal recess or sinus
disease and surgeon expertise. In that regard, tympani. On this detail, it is worth mentioning
it was common for a surgery to start as a CWU otovideoendoscopy as a breaking technology
procedure, and then be converted to CWD which has proven to reduce the incidence
whenever deemed necessary. of residual cholesteatomas by enabling
In our series, the most frequent reasons for identification of lesions in difficult access areas
performing a CWD tympano-mastoidectomy under otomicroscopy. This technology, which
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were an extensive disease present in difficult can be an added value, was not available in
access areas (S1 and S2), recidivism, erosion of our institution during the reviewed surgeries.
the posterior external auditory canal or lateral On the other hand, intermittent otorrhea
semicircular canal, low volume mastoids, affecting quality of life was more commonly
presence of cholesteatoma in an only hearing seen in the CWD group, probably due to the
ear, high surgical risk and a low likelihood of increased risk that an exposed open cavity
adequate follow-up. has of becoming infected if the required
Furthermore, in the same surgical time, preventive measures are not followed.
ossicular reconstruction was carried out using Regarding follow-up, it’s important to note
a myriad of different techniques and materials, that a significantly higher discharge rate was
which have been previously described but seen in the CWU group, as expected, given
were not subjected to a comparative analysis the main advantage of a self-cleaning ear. We
given the low number of cases we had for also point out the seemingly large proportion
each different type. of patients who had a loss of follow-up. This
When comparing hearing outcomes from occurrence may have a significant negative
CWU and CWD approaches we also found impact on the long-term prognosis for these
contrasting reports in literature. While most patients. Although not completely understood,
studies fail to find any significant difference loss of follow-up in our cohort can be in part
between the two approaches. 15-17 some explained by the constraints of medical care
reported better hearing results with CWU during the COVID-19 pandemic and the
procedures 4,18 while the opposite has also significant proportion of patients who have
been described . Our results demonstrated a changed their residence, including emigrants,
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minimal worsening of hearing in both groups commonly reported in our population.
after surgery and support the notion that the
preservation or not of the posterior canal wall
has no significant influence on hearing results,

170 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço