Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

Bhat, K Vikram; Naseeruddin, Khaja; Nagalotimath, Umesh; Kumar, Pratik; Hegde, Jyotirmay S

doi:10.1017/s0022215108003708

Cited by 40 publications

(51 citation statements)

References 19 publications

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“…A single-blinded, randomized, controlled study within a tertiary referral hospital was conducted by Bhat et al [8] in 2008, to compare outcomes for mastoidotympanoplasty and for tympanoplasty alone in cases of quiescent, tubotympanic, chronic, suppurative otitis media. There were no statistically significant differences in hearing improvement, tympanic perforation closure, graft uptake or disease eradication, comparing the two groups at 3 and 6 months post-operatively.…”

Section: Discussionmentioning

confidence: 99%

Success of Myringoplasty: Our Experience

Kamath

Sreedharan

Rao

et al. 2013

Indian J Otolaryngol Head Neck Surg

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The purpose of this study is to compare the efficacy of myringoplasty with or without cortical mastoidectomy in terms of freedom from discharge, graft take up and improvement in hearing. This is a Clinical prospective study of 120 patients from among a group of patients with chronic suppurative otitis media. A detailed history and examination was conducted including pure tone audiogram. Patients were randomly divided into two groups; group A would undergo myringoplasty only and group B would undergo cortical mastoidectomy with myringoplasty. Patients were reviewed after 3 weeks for inspection of the operated ear. Second post-operative review was at 3 months for clinicoaudiological assessment. Group B was found to have slightly more improvement as compared to the other group. No significant difference in the success rates of graft take-up in patients with unilateral or bilateral disease was found. Higher take up rates were seen in large (91.83 %) and medium perforations (90.69 %). In all our failed cases, post-operative ear discharge continued to be a persistent and troubling problem. The average audiological gain was 12.88 dB in group B, whereas it was 12.40 dB in group A. The reduction of air bone gap within each group was found to be significant. There is no statistical significant data indicating that tympanoplasty with mastoidectomy yields better results. When considering the addition of a mastoidectomy to a Tympanoplasty, the performing surgeon should consider not only the potential added benefit but also potential risks and costs to the patient.

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Section: Discussionmentioning

confidence: 99%

Success of Myringoplasty: Our Experience

Kamath

Sreedharan

Rao

et al. 2013

Indian J Otolaryngol Head Neck Surg

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“…[8][9][10][11][12][13][14][15][16][17] Traditionally it has been a common belief that tympanoplasty should be done in a totally dry ear to obtain a successful surgery, but slowly surgeons have started performing tympanoplasty alone even for quiescent and of late even for wet ears.…”

Section: Discussionmentioning

confidence: 99%

“…Bhat et al had conducted a single blinded randomized controlled study comparing the outcomes of mastoidotympanoplasty and tympanoplasty alone, in cases of tubotympanic CSOM in quiescent stage, in which they had found no statistically significant difference between the two groups. 8 Mastoidectomy itself carries risk of several complications like damage to the incus, dura, sigmoid sinus, labyrinth and facial nerve. 9 Panigrahi et al stated in their study that in well selected cases, meticulously done simple myringoplasty is enough to give a dry ear and healthy neotympanum and if cortical mastoidectomy improves the graft success rate then it is worth to ignore the risks involved, otherwise it is an unnecessary adjunct procedure.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study

Gayathri

Balachandran

Rathnasamy

et al. 2016

Int J Otorhinolaryngol Head Neck Surg

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Background: As the role of cortical mastoidectomy as an adjunct to tympanoplasty in the management of CSOM tubotympanic type - quiescent stage remains controversial even today; we intend to study the factors that influence the decision of ENT surgeons on whether or not to perform cortical mastoidectomy in patients with CSOM (chronic suppurative otitis media) - active or quiescent ear.Methods: During May to August 2016, 60 ENT surgeons within Chennai were asked to answer a pre-framed questionnaire on CSOM based on their personal surgical experience. The answers were collected by direct questionnaire method and the data subjected to appropriate statistical analysis.Results: 65% surgeons expected a minimum dry ear period of ≤30 days before considering tympanoplasty alone (group 1) and the rest 35% members expected more than 30 days of dry ear period (group 2). Surgeons ≤40 years of age expected lesser duration of dry ear period prior to consideration of tympanoplasty alone (p =0.016). Group 2 surgeons performed cortical mastoidectomy in more number of cases (>50%) when compared to group 1 surgeons (p =0.03) for patients who presented first to them with a wet ear. There was a mixed opinion among surgeons within group 1 itself on whether or not they would do cortical mastoidectomy when they encountered patients who had congested remnant tympanic membrane, congested middle ear mucosa, myringosclerosis, ossicular chain discontinuity, sclerotic mastoids or treated septic foci in spite of the ear being dry for a month.Conclusions: Though many surgeons consider that 30 days of dry ear period is sufficient to consider tympanoplasty alone, there is a division of opinion among themselves while facing specific clinical scenarios.

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“…As a precautionary measure many surgeons perform both the procedure routinely to avoid recurrence and graft failure. 2 The advantage and disadvantages of cortical mastoidectomy has long been the focus of controversies and debate among the otologists. The mastoidectomy itself carries several complication risks like damage to the incus, dura, sigmoid sinus, labyrinth and facial nerve.…”

Section: Introductionmentioning

confidence: 99%

Role of Cortical Mastoidectomy in Outcome of Myringoplasty in Active and Quiscent Stage of Tubotympanic Type of Chronic Suppurative Otitis Media

Panigrahi¹,

R²,

Pani³

2015

jemds

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OBJECTIVE:To study the role of cortical mastoidectomy in terms of graft success rate in cases of myringoplasty in wet and quiescent ear. METHODS: A prospective comparative study was conducted. Cortical mastoidectomy with myringoplasty was done in one group where as in another group only myringoplasty was done without cortical mastoidectmy. Graft success rate was compared in both the groups. RESULTS: Graft success rate for patients with mastoidectomy and without mastoidectomy after one year observation period were 89.5and 87.3%, respectively. CONCLUSION: Cortical mastoidectomy had no additional benefit to the graft success rate in cases of myringoplasty.

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Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

Abstract: Mastoidotympanoplasty was not found to be superior to tympanoplasty alone over a short term follow-up period. Hence, it may not be necessary to undertake routine mastoid exploration at this stage of disease.

Cited by 40 publications

References 19 publications

Success of Myringoplasty: Our Experience

Success of Myringoplasty: Our Experience

Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study

Role of Cortical Mastoidectomy in Outcome of Myringoplasty in Active and Quiscent Stage of Tubotympanic Type of Chronic Suppurative Otitis Media

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