Chronic otitis media: surgical failures and management.

Abstract

Failure of primary tympanomastoid surgery to control chronic otitis is a difficult otologic problem. The facial nerve, middle fossa dura, and inner ear structures are at high risk because of distorted anatomy from the primary surgery and/or recurrent disease. In this article our techniques and experience with 42 revision procedures for recurrent chronic otitis with and without cholesteatoma are presented. Control of otorrhea and/or cholesteatoma was achieved in 93% of the cases; however, this might be less after 5 years of follow-up. The mean postoperative air-bone gap was 25 dB, and this is a 6 dB improvement from the preoperative level. Revision tympanomastoid surgery was very effective and safe in the management of this difficult problem. For cholesteatoma in particular, the canal wall down technique is our procedure of choice.