Study design and patient selection
In this prospective longitudinal study, adult patients undergoing surgery for CMED were assessed for inclusion. Patients were recruited from a tertiary hospital (RM, NWM). Patients received autologous reconstruction material (local pediculed muscle flaps, bone paté, temporal muscle fascia and cartilage) when the mastoid cavity was obliterated and/or to reconstruct the posterior canal wall. In cases of involvement of the ossicles, ossiculoplasty (TTP-Variac System, Heinz Kurz GmbH, Dusslingen, Germany) was performed to improve the hearing. Patients underwent pure-tone audiometry and completed the ZCMEI-21 both pre- and postoperatively.