Radical Mastoidectomy With Cavity Obliteration

Abstract

Obliteration of the mastoid cavity leaves a smaller cavity with quicker as well as better healing. Chances of developing cavity granulations or infection are also reduced. Protection of the lateral semicircular canal by soft tissue obliteration also prevents vertigo episodes on exposure to cold air. This prospective study was to compare the results of pediatric modified radical mastoidectomy (MRM) in open mastoid cavities and cavities obliterated with periosteal-temporofascial swing flap at Manipal Teaching Hospital, Pokhara; a tertiary referral centre. The cohort comprised of 40 pediatric patients who underwent MRM between January 2012 and December 2014. They were divided into group 1 where mastoid cavity was kept open and group 2 where mastoid cavity was obliterated with periosteal-temporofascial swing flap plus medicated bone dust. Results in the 2 groups were assessed by comparing the time taken for mastoid cavity to become dry, incidence of vertigo on exposure to cold air, tympanic membrane graft status, mastoid cavity status and change in the pre-operative to post-operative pure tone average after 6 months. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Statistical significance was set at p<0.05. Group 1 vs. Group 2 results were as follows: Mean time taken for mastoid cavity to dry was 81.8 days vs. 30.1 days. Vertigo on exposure to cold air was present in 77.3% vs. 0%. Tympanic membrane graft status was intact in 72.7% vs. 100%. Mastoid cavity epithelialization was complete in 68.2% vs. 94.4%. Mastoid cavity granulations were present in 36.4% vs. 5.6%. Mastoid cavity healing rates were 63.6% vs. 94.4%. Residual cholesteatoma was seen in 4.5% vs. 0%. Excessive wax & keratin debris was present in 36.4% vs. 5.6%. External auditory canal opening was adequate in 86.4% vs. 94.4%. The mean post-operative pure tone average was 37.61 dB vs. 25.97 dB. Mean gain in pure tone average was 8.94 dB vs. 19.84 dB. None of the patients developed intra-cranial complications. Periosteal-temporofascial swing flap plus medicated bone dust obliteration of pediatric MRM cavity provides a dry and healed cavity in less time with better hearing when compared to an open MRM cavity.

Late Changes in Hearing Results After Mastoid Obliteration With Tympanoplasty

“…Also in the group with no ossicular reconstruc¬ tion, the late change after the first postoperative year was, on the aver¬ age, relatively great (6.1 dB) and this group was the only one where the hearing, on the average, deteriorated from the preoperative level. The results are in agreement with those reported by Palva et al 5 The changes in mean air-bone gaps were caused by improvement in air conduction hearing thresholds be¬ cause the changes in the mean bone conduction hearing thresholds were not significant in any of the groups IA to IIB or in the subgroups. There were deteriorations of more than 10 dB in mean bone conduction thresholds in a few ears, indicating sensorineural high-tone loss following surgery.…”

“…The air-bone gap in group IA (the posterior bony canal wall pre¬ served) deteriorated during the fol¬ low-up after the first year significant¬ ly less than in group IIA (the posteri¬ or bony canal wall removed) (P < .05; Tables 1 and 3). 5. The changes in the air-bone gap at the end of the first year of followup did not statistically differ between the various subgroups a to / in the groups IA to IIB, as was also true for the changes in the gap between the early and late follow-ups.…”

Permanent Middle-Ear Aeration in Tympanoplasty

“…The late results following tympanoplasty have been poorer than the initial results in all reported series [Pfaltz et al, 1962;Palva et al, 1968;Rentzsch, 1969;Tos, 1974]. Therefore, particularly poor late results would have been expected in the present difficult group of patients in whom adhesive changes predominated.…”

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

“…Obliteration of the mastoid cavity was first reported by Mosher in 1911, 3 and this technique was further modified and popularized in the 1960s by Palva et al 6 Since Mercke 7 reported good outcomes in CWD surgery with obliteration for cholesteatoma surgery, the concept of obliteration has been taken up by many otologists. This has led to the development of different obliteration techniques, with several obliteration materials.…”