Reconstruction and Obliteration of Mastoid Cavities Using Autologous Bone Dust and Conchal Cartilage: Restoring a Self-Cleaning, Waterproof and Acoustically Functional Ear
DOI:
https://doi.org/10.32412/pjohns.v40i2.2729Keywords:
mastoidectomy, reconstructive surgical procedures, bone transplantation, cartilage, auricular, cholesteatoma, middle ear, magnetic resonance imaging, diffusion-weighted, postoperative care, hearingAbstract
Objective: To describe a practical surgical approach for mastoid cavity obliteration and canal wall reconstruction using autologous bone dust and conchal cartilage applied either during primary canal wall up (CWU) surgery or in revision of prior canal wall down (CWD) mastoid cavities, with the aim of restoring a self-cleaning, waterproof ear that retained its natural acoustic resonance.
Methods: The indications, surgical technique, and follow up and imaging surveillance were described, detailing patient selection, harvesting and application of autologous materials, and the key technical steps for cavity obliteration and posterior canal wall reconstruction. The importance of preserving the ear canal’s standing wave resonance (~2000–2500 Hz) for optimal hearing was emphasized. Postoperative monitoring with non-echo planar diffusion-weighted imaging (DWI) MRI was recommended at least 1.5 years after surgery to detect residual or recurrent cholesteatoma.
Results: This technique was performed successfully in 88 patients (32 males and 56 females, aged 6–80 years) across four hospitals in Metro Manila from January 2020 to July 2025. All patients had unremarkable postoperative courses and healed within three months. Among the 67 who underwent DWI MRI after 18 months, two required revision mastoidectomies with mastoid obliteration for cholesteatoma recidivism—one with residual and one with recurrent disease.
Conclusion: Mastoid obliteration and reconstruction using autologous bone dust and cartilage has proven to be a safe, effective and cost-efficient technique. It converts problematic open cavities into dry, self-cleaning ears suitable for swimming while preserving the acoustic benefits of a near-normal ear canal. Long-term follow-up with diffusion-weighted imaging (DWI) MRI is essential to ensure durable disease control.
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Copyright transfer (all authors; where the work is not protected by a copyright act e.g. US federal employment at the time of manuscript preparation, and there is no copyright of which ownership can be transferred, a separate statement is hereby submitted by each concerned author). In consideration of the action taken by the Philippine Journal of Otolaryngology Head and Neck Surgery in reviewing and editing this manuscript, I hereby assign, transfer and convey all rights, title and interest in the work, including copyright ownership, to the Philippine Society of Otolaryngology Head and Neck Surgery, Inc. (PSOHNS) in the event that this work is published by the PSOHNS. In making this assignment of ownership, I understand that all accepted manuscripts become the permanent property of the PSOHNS and may not be published elsewhere without written permission from the PSOHNS unless shared under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.
