Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: Is it necessary?

Abstract

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow-up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).

A Comparative Study of Temporalis Fascia Graft and Vein Graft in Myringoplasty

“…Balyan et al [25] operated discharging ear with sclerotic mastoid and showed that there was no statistically significant differences between the outcome of myringoplasty in patients who had undergone simple mastiodectomy plus myringoplasty and those without mastoidectomy. But in the study of Puhakka et al [8] the results were significantly poor if preoperative X-Ray mastoid was sclerotic.…”

Comparative evaluation of surgical and audiological outcomes in patients of chronic suppurative otitis media with dry ear treated by myringoplasty with or without simple mastoidectomy

“…10 In a study done by Toros et al tympanic membrane perforation closure was successful in 76.1% of the 46 patients undergoing myringoplasty and in 78.3% (n=36) of the 46 patients undergoing Myringoplasty with mastoidectomy. The difference between the closure rates of the two groups was not statistically significant (p>0.05).…”

MASTOID SURGERY: Clinical Findings, Radiological findings& Technique of Mastoid Surgery in Khartoum ENT Hospital and Omdurman military hospital

“…Some authors believe that mastoidectomy is not necessary for treatment of all non cholesteatomatous ears 7 . However, some believe that addition of mastoidectomy greatly increases the success of tympanoplasty 8 .…”