Mastoid Obliteration in Addition to the Canal Wall Up Tympanomastoidectomy: A Systematic Review.

PURPOSE: This systematic review aimed to summarize the available evidence on clinical, patient-related, and economic outcomes of the canal wall up (CWU) tympanomastoidectomy, with and without the obliteration technique in surgical cholesteatoma care. METHODS: A comprehensive search was conducted in PubMed, Embase, Cochrane, Scopus, ClinicalTrials.gov, and the EU Clinical Trials Register. The NHS EED database was also searched for economic evaluations. All searches were completed by July 7, 2025. Studies were included if they evaluated the obliteration technique alongside CWU or compared it to CWU without obliteration in adults. The primary outcome was recurrent/residual disease. Secondary outcomes included hearing results, complications, quality of life, and economic evaluations. Two authors independently screened and included the literature; quality assessment was assessed by all authors and determined by consensus. RESULTS: Four comparative and 5 noncomparative retrospective studies addressed the primary outcome. Surgical complications were reported in all but one of the articles. Three additional studies focused on secondary outcomes: 2 on quality of life and 1 on hearing. No studies were identified on economic evaluations or cost analyses. Furthermore, no prospective studies or randomized controlled trials were found. CONCLUSION: The results of nearly all included studies indicate a reduction in recidivism rates when the obliteration technique is added to the canal wall up (CWU) approach. However, no high-level evidence studies are currently available, and the existing studies are likely subject to confounding factors. In addition, significant heterogeneity among the studies limits the ability to draw definitive conclusions at this stage.