Are head bandages really required after middle-ear surgery? A systematic review

Abstract

Current available evidence shows no advantage of head bandage use after middle-ear surgery. Head bandages may not be required after routine, uncomplicated middle-ear surgery.

Pressure dressings in mastoid and middle ear surgery: are they necessary? A retrospective review of patient outcomes

“…A mastoid pressure dressing consists of a circumferential head bandage overlying non‐stick padded dressings, such as gauze swabs, placed over the pinna, which applies pressure to the surgical area . The purpose of this dressing is to prevent the potential dead space that may cause haematoma or seroma formation, which can result in pinna protrusion or wound breakdown and infection …”

“…One study measured the pressure applied by head bandages and found that after the first hour the head bandage lost the pressure required to prevent haematoma formation . The variability in the duration of pressure dressing application is also a confounder in the interpretation of adverse events, such as headache and skin irritation, reported in studies from various institutions . Such minor complications would be considered more likely with prolonged use of pressure dressings as the collection of blood and the environment under the mastoid pressure dressing may promote bacterial proliferation and increase the risk of infection .…”

“…The application of post-operative mastoid pressure dressings became widely accepted as best practice in the 1950s following the first use of temporalis fascia grafts in middle ear surgery. 1,2 Since that time, the use of pressure dressings following tympanoplasty, tympanomastoidectomy and cochlear implantation has become standard practice in most centres around the world. 1 A mastoid pressure dressing consists of a circumferential head bandage overlying non-stick padded dressings, such as gauze swabs, placed over the pinna, which applies pressure to the surgical area.…”

“…1,2 Since that time, the use of pressure dressings following tympanoplasty, tympanomastoidectomy and cochlear implantation has become standard practice in most centres around the world. 1 A mastoid pressure dressing consists of a circumferential head bandage overlying non-stick padded dressings, such as gauze swabs, placed over the pinna, which applies pressure to the surgical area. 3,4 The purpose of this dressing is to prevent the potential dead space that may cause haematoma or seroma formation, which can result in pinna protrusion or wound breakdown and infection.…”

“…3,4 The purpose of this dressing is to prevent the potential dead space that may cause haematoma or seroma formation, which can result in pinna protrusion or wound breakdown and infection. 1,3,5 Modern intra-operative haemostatic techniques such as bipolar cautery forceps and monopolar cutting, introduced in the 1950s, have obviated the need for prolonged application of mastoid pressure dressings. 1 The continued use of these dressings in uncomplicated middle ear and mastoid surgery is likely driven by historical practice and teaching.…”