Re: question about repeated surgeries...

[Guest guest]

Hmm, well, 80% is about what the doc gave us after this last CWU. So I'm not sure where that leaves us. Thanks for the info...this is something I'm going to have to look into and think about for awhile. Luckily (at least something's going lucky here), we have about 9 months to do all that.

Thanks again,

Marie

[Guest guest]

Hi there,

I'm new and I don't understand the lingo. What is CWD and CWU? Also, what do you mean by reconstruction? Some people have mentioned that their surgeries remove the ear and some mention that the ear canal is reconstructed. I think my doctor is going to just make an incision behind my ear. Maybe I misunderstood.

karenwe4counts@... wrote:

Hi All,My son just had another tympanomastoidectomy last week. He is recovering very well. The surgeon said it looked to him like the eustachian tube is starting to work (combo of tonsillectomy, adenoidectomy, getting bigger, and diet) and the middle ear looks healthier. He could see signs of past infection, but no current active infection. This was the good news.The bad news was that the surgeon didn't feel as confident as he wanted to that he had got all the ctoma. So he wants to do another 2nd look surgery in 6-9 months. I expected him to tell me that if he saw more regrowth at that point, it would be time to go to the CWD. However, instead he said that if he found more regrowth, we would be faced with the same choices we had this time (that is, if it looked bad go to CWD, if it

wasn't so bad stay with CWU and try to work more on the eustachian tube).The surgery last week was my son's 5th surgery. He had his first removal in April 2002, then in Oct 2002 second-look which found 3 tiny spots of regrowth to remove and the surgeon (different guy who left the state since) played the odds and went ahead with reconstruction. In Oct 2003, we had a second removal, then that surgeon went out on maternity leave. So, we had a check up with a different guy (the surgeon who did last week's) and he suggested trying the tonsillectomy, etc... instead of going straight to the CWD. So, in May 2004, Curtis had the tonsils/adenoids out. Then last week, Aug 2004, another CWU. The surgery now under discussion would be the 6th... now, I've heard it mentioned several times on this list that the rule is 2 removals, then CWD. On the one hand, I'm sure we might have got an extra surgery or 2 in here because we had to change surgeons so many times; on the other, I don't want to

give up too soon if the eustachian tube is starting to look better.What do you guys think of this situation?Thanks,Marie

[Guest guest]

:

I think that Phil has published the definations of the

CWD and CWU on the home page for c-toma. But

basicly, the CWU removes part of the ear canel wall in

between the canel and the mastoid region to allow

cleaning the matoid bone. The CWD removes the canel

wall to allow total removal of the mastoid bone. The

mastiod bone is a porist type of a bone and absorbs

c-toma into it. Thats the most common reason why

folks have reacurring c-toma is that it has moved into

the mastoid. Once it gets in there it is almost

impossible to treat other than for the CWD.

Reconstruction in general implies that the hearing

bone are being replaced with new bones or artifical

bones...

tom hansen

--- karen michael <rarekare35@...> wrote:

> Hi there,

> I'm new and I don't understand the lingo. What is

> CWD and CWU? Also, what do you mean by

> reconstruction? Some people have mentioned that

> their surgeries remove the ear and some mention that

> the ear canal is reconstructed. I think my doctor

> is going to just make an incision behind my ear.

> Maybe I misunderstood.

> karen

>

> we4counts@... wrote:

> Hi All,

>

> My son just had another tympanomastoidectomy last

> week. He is recovering very well. The surgeon said

> it looked to him like the eustachian tube is

> starting to work (combo of tonsillectomy,

> adenoidectomy, getting bigger, and diet) and the

> middle ear looks healthier. He could see signs of

> past infection, but no current active infection.

> This was the good news.

>

> The bad news was that the surgeon didn't feel as

> confident as he wanted to that he had got all the

> ctoma. So he wants to do another 2nd look surgery in

> 6-9 months. I expected him to tell me that if he saw

> more regrowth at that point, it would be time to go

> to the CWD. However, instead he said that if he

> found more regrowth, we would be faced with the same

> choices we had this time (that is, if it looked bad

> go to CWD, if it wasn't so bad stay with CWU and try

> to work more on the eustachian tube).

>

> The surgery last week was my son's 5th surgery. He

> had his first removal in April 2002, then in Oct

> 2002 second-look which found 3 tiny spots of

> regrowth to remove and the surgeon (different guy

> who left the state since) played the odds and went

> ahead with reconstruction. In Oct 2003, we had a

> second removal, then that surgeon went out on

> maternity leave. So, we had a check up with a

> different guy (the surgeon who did last week's) and

> he suggested trying the tonsillectomy, etc...

> instead of going straight to the CWD. So, in May

> 2004, Curtis had the tonsils/adenoids out. Then last

> week, Aug 2004, another CWU. The surgery now under

> discussion would be the 6th... now, I've heard it

> mentioned several times on this list that the rule

> is 2 removals, then CWD. On the one hand, I'm sure

> we might have got an extra surgery or 2 in here

> because we had to change surgeons so many times; on

> the other, I don't want to give up too soon if the

> eustachian tube is starting to look better.

>

> What do you guys think of this situation?

>

> Thanks,

> Marie

>

>

[Guest guest]

Hi

It's hard to find definitons which are easy to understand. Canal Wall Up and Canal Wall Down both involve an incision behind the ear - it's what is done once they're inside that makes the difference.

Basically

• Canal Wall Up (or closed) Mastoidectomy. The surgeon opens the mastoid bone and removes the infected air cells. The middle ear space is accessed by cutting the eardrum to drain the middle ear and remove the ctoma. It will also remove any of the middle ear bones that are diseased or damaged but will preserve as much of the ear as possible.

• Canal Wall Down - Modified radical mastoidectomy. This follows the same pattern except that back part of the ear canal wall is removed. effectively the mastoid opens up on to the ear canal and this creates a much wider access to the middle ear. It also aims to preserve as much of the eardrum and the middle ear structures as possible.

• Canal Wall Down - Radical mastoidectomy. In this a portion back part of the ear canal is and the eardrum and the middle ear structures are removed (if there are any left to remove). This surgery was once the norm but is no longer used except in very severe cases. It means that the middle ear mastoid and ear canal are left as one big open cavity with nothing in there. It used to be that reconstruction would never be possible after this surgery but that is beginning to change.

The advantage of the CWD is that ctoma recurrence is less likely and it would be easier to get at if it did come back. The disadvantages are that it takes longer to heal, the ear will probably need regular cleaning and you have to try to avoid getting water in there.

Reconstruction refers to rebuilding the chain of hearing bones usually with a prosthetic which replaces all or part fo those bones. It may also involve grafting in a new eardrum and rebuilding the middle ear itself with cartilage and skin grafts.

Phil

Re: question about repeated surgeries...

Hi there,

I'm new and I don't understand the lingo. What is CWD and CWU? Also, what do you mean by reconstruction? Some people have mentioned that their surgeries remove the ear and some mention that the ear canal is reconstructed. I think my doctor is going to just make an incision behind my ear. Maybe I misunderstood.

karenwe4counts@... wrote:

Hi All,My son just had another tympanomastoidectomy last week. He is recovering very well. The surgeon said it looked to him like the eustachian tube is starting to work (combo of tonsillectomy, adenoidectomy, getting bigger, and diet) and the middle ear looks healthier. He could see signs of past infection, but no current active infection. This was the good news.The bad news was that the surgeon didn't feel as confident as he wanted to that he had got all the ctoma. So he wants to do another 2nd look surgery in 6-9 months. I expected him to tell me that if he saw more regrowth at that point, it would be time to go to the CWD. However, instead he said that if he found more regrowth, we would be faced with the same choices we had this time (that is, if it looked bad go to CWD, if it wasn't so bad stay with CWU and try to work more on the eustachian tube).The surgery last week was my son's 5th surgery. He had his first removal in April 2002, then in Oct 2002 second-look which found 3 tiny spots of regrowth to remove and the surgeon (different guy who left the state since) played the odds and went ahead with reconstruction. In Oct 2003, we had a second removal, then that surgeon went out on maternity leave. So, we had a check up with a different guy (the surgeon who did last week's) and he suggested trying the tonsillectomy, etc... instead of going straight to the CWD. So, in May 2004, Curtis had the tonsils/adenoids out. Then last week, Aug 2004, another CWU. The surgery now under discussion would be the 6th... now, I've heard it mentioned several times on this list that the rule is 2 removals, then CWD. On the one hand, I'm sure we might have got an extra surgery or 2 in here because we had to change surgeons so many times; on the other, I don't want to give up too soon if the eustachian tube is starting to look better.What do you guys think of this situation?Thanks,Marie