Role of the mastoid in tympanic membrane reconstruction

Abstract

Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an "air reservoir" which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.

Audiological evaluation in between patients with type 1 tympanoplasty alone and type 1 tympanoplasty with cortical mastoidectomy

“…4 Our study showed similar results with a 100% take up in cases with large mastoids and 73.6% take up rates with small mastoids.…”

“…Jackler and Schindler the graft take up rates were found to be 86.7% for subtotal perforations and 76.5% for medium sized perforations. 4 In contrast to the above, a study by Adkin et al showed only 61% take-up rates with subtotal perforations compared to 98% in medium sized perforations. 5 Our study results were similar to Adkin et al, series showing poor take up rates with subtotal perforations (42%) compared to medium sized perforations (100%).…”

Success of Myringoplasty: Our Experience

“…Jackler and Schindler [3] in 1984 studied 48 patients with chronic otitis media with tympanic perforations who underwent myringoplasty with mastoidectomy. In their study it was found that, simple mastoidectomy was found to be an effective means of re-pneumatizing the sclerotic mastoid and eradicating mastoid sources of infection.…”

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

“…Mastoid size does not have any effect on healing of tympanic membrane perforation [16]. It has been found that all the small sized mastoids were associated with inflammatory disease of the mucosa and in no case with a medium or large size mastoid system showed signs of inflammation at operation [16]. There was no statistically significant difference between the inflamed and non-inflamed types of mastoid on healing of tympanic membrane perforation [16].…”

“…But in the study of Puhakka et al [8] the results were significantly poor if preoperative X-Ray mastoid was sclerotic. Mastoid size does not have any effect on healing of tympanic membrane perforation [16]. It has been found that all the small sized mastoids were associated with inflammatory disease of the mucosa and in no case with a medium or large size mastoid system showed signs of inflammation at operation [16].…”