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

O’Brien, J; Ruskin, Olivia; Price, Tim

doi:10.1111/ans.14370

Cited by 4 publications

(7 citation statements)

References 9 publications

(44 reference statements)

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“…6,7 The use of a mastoid dressing has been a convention practiced since temporalis fascia graft usage in the 1950's by Heerman. 4,8 However, Hill et al proved that the actual pressure indices of a mastoid dressing are inadequate to prevent hematoma formation. 1 Rowe-Jones et al brought the practice in question in 1993 with a series of 100 cases, while Castelli et al performed a study on over 400 individuals during a 6 year period.…”

Section: Discussionmentioning

confidence: 99%

“…3 O'Brien et al have curtailed the time of mastoid dressing to 2 hours post-surgery and recommended that the patients be discharged post removal; and that the presence of a head dressing must not be a factor in decision making for a day care procedure or not. 4 However, keeping in mind the Indian populace with a majority of patients belonging to a lower socio-economic strata. 5 Prudence dictates that the said recommendations can only be accepted in India after due deliberation.…”

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confidence: 99%

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Mastoid Dressing in Ear Surgery: Is it Still Relevant?

Naga¹,

Bedi²,

Rajguru³

et al. 2021

BJOHNS

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Introduction Mastoid dressings are conventionally used in patients who undergo Tympanoplasty using post auricular approach. The rationale behind using a mastoid dressing is that the said dressing prevents haematoma formation and acts as a protective covering during the post-operative period. This study aims to understand the significance of mastoid dressing in patients undergoing Cortical Mastoidectomy and Tympanoplasty and its role in preventing post-operative wound complications and patient comfort. Materials and Methods A total of 77 patients were enrolled in the study over a one year period and were randomised into dressing and no dressing groups with the aim of deciphering any advantage of the mastoid dressing over a smaller dressing. Results Our data revealed no added advantage of conventional mastoid dressing over a small gauze piece dressing in terms of haematoma/seroma formation, contusion and wound dehiscence. However, there was significantly reduced patient discomfort and sleeping difficulties post-operatively in the no dressing group. Conclusion We conclude that smaller dressing is more favourable than the bulkier conventional mastoid dressings.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mastoid Dressing in Ear Surgery: Is it Still Relevant?

Naga¹,

Bedi²,

Rajguru³

et al. 2021

BJOHNS

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“…We recorded postoperative as described in previous studies. 8,9 Complications were defined as adverse events that were managed by medical measures, conservative treatment or required surgical procedures. Examples are surgical site infection (SSI), wound dehiscence, seroma, bleeding and haematoma.…”

Section: Methodsmentioning

confidence: 99%

“…4 Some prior studies that investigated the efficacy of applying MPD following cochlear implantation and middle ear surgery in adults showed no significant difference in the rate of wound complications. 7,8 Regardless, the efficacy issue remains unresolved, with most institutions continuing to apply MPD to patients undergoing mastoidectomy, including children. No data has been published about MPD applied to children following mastoidectomy in a contaminated surgical site such as that found in cholesteatoma and chronic ear disease, and their relation to post-operative pain.…”

Section: Introductionmentioning

confidence: 99%

No difference in wound complications with or without a post‐operative pressure dressing: Our experience in 135 children undergoing mastoidectomy

Shinnawi

Gordin

Zaroura

et al. 2022

Clinical Otolaryngology

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Objectives To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and post‐operative pain. Design A retrospective controlled study. Setting All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants Children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010 to 2021. Main Outcome Measures Wound‐related complications and Visual Analogue Scale (VAS) pain scores at discharge were compared between children who had an MPD applied following surgery and those who did not. Results One hundred thirty‐five cases were included. The demographic characteristics of the patients and surgical techniques employed were similar for both groups. There were 91 patients in the MPD group and 44 in the non‐mastoid dressing (NMPD) group. In the MPD group, five patients developed minor wound dehiscence, eight experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had an SSI, one patient suffered from a keloid scar, wound dehiscence was observed in one patient, and another one had a local hematoma. Therefore, there were no differences between the groups in relation to post‐operative complications (p = .32). Despite these similitudes, the NMPD patients suffered less post‐operative pain, as measured by the VAS (p = .02). Conclusion This study shows that no significant benefit is derived from using an MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent post‐operative wound complications. Our study supports the abandonment of routine MPD in children following mastoidectomy.

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“…In addition, the sight of a child's head wrapped in a large mastoid pressure dressing may cause parents to experience increased stress and concern. Some prior studies that investigated the efficacy of applying mastoid pressure dressings following cochlear implantation and middle ear surgery in adults showed no significant difference in the rate of wound complications 7,14 . In fact, other reports revealed an increase in wound complications among patients upon whom a mastoid pressure dressing was applied after middle ear surgery 8,13,15 .…”

Section: Introductionmentioning

confidence: 98%

Is There Utility in Using Mastoid Pressure Dressing in Children Undergoing a Mastoidectomy?

Shinnawi

Gordin

Zaroura

et al. 2021

Preprint

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Objectives: To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and postoperative pain. Design: A retrospective controlled study. Setting: All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD. Participants: children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010-2020. Main outcome measures: Wound-related complications and visual analog scale (VAS) pain scores at discharge were compared between children who had a MPD applied following surgery and those who did not. Results: 119 cases were included. The demographic characteristics of the patients and surgical techniques employed similar for both groups. There were 91 patients in the MPD group and 28 in the non-mastoid dressing (NMPD) group. In the MPD group, 5 patients developed minor wound dehiscence, 8 experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had a SSI, while another had a local hematoma. Therefore, there were no differences between the groups in relation to postoperative complications (p = 0.47). Despite these similitudes, the NMPD patients suffered less postoperative pain, as measured by the VAS (p =.02). Conclusions: This study shows that no significant benefit is derived from using a MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent postoperative wound complications. Our study supports the abandonment of routine MPD on children following mastoidectomy.

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

Abstract: Removal of mastoid pressure dressings 2 h following ear surgery is safe and effective. Furthermore, a mastoid dressing should not be a factor in the decision as to whether to treat a patient as a day case or overnight admission.

Cited by 4 publications

References 9 publications

Mastoid Dressing in Ear Surgery: Is it Still Relevant?

Mastoid Dressing in Ear Surgery: Is it Still Relevant?

No difference in wound complications with or without a post‐operative pressure dressing: Our experience in 135 children undergoing mastoidectomy

Is There Utility in Using Mastoid Pressure Dressing in Children Undergoing a Mastoidectomy?

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