Mastoidectomy

Choosing Canal Wall Up (CWU) versus Canal Wall Down (CWD) Mastoidectomy

The CWU mastoidectomy is now the most commonly performed type of mastoidectomy in the United States. Factors that may make a surgeon choose a CWD procedure as opposed to a CWU mastoidectomy include:

• severe or life-threatening disease
• an only hearing ear (CWD mastoidectomy has a smaller risk of damaging the inner ear)
• a deaf ear
• poor health that may preclude longer or repeated surgeries
• patient with limited access to health care

Also, children with cholesteatoma are more likely to need a CWD mastoidectomy because they tend to have more aggressive disease than adults. Clearly, one type of mastoidectomy is not optimal for all patients. Any ear surgeon should be capable of performing both types of mastoidectomy well and knowing when the use of each is appropriate. It is sometimes difficult to know exactly what technique will be best until actually doing the surgery. Most surgeons in this situation use a flexible approach; plan on a CWU technique, but convert to a CWD if needed.