Effectiveness of advanced surgical techniques in resolving refractory chronic otitis media in children: a narrative review of clinical, functional, and auditory outcomes

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Chronic Suppurative Otitis Media (CSOM) is a prevalent middle ear condition, particularly in children, characterised by persistent otorrhoea and tympanic membrane perforation. This condition can lead to hearing loss and, if left untreated, serious complications. Refractory CSOM, defined as ongoing or recurrent infections despite medical treatment, often requires surgical intervention, including tympanoplasty and tympanomastoidectomy. This narrative review aims to evaluate the effectiveness of these advanced surgical techniques in resolving CSOM in pediatric patients, focusing on clinical, functional, and auditory outcomes. An integrative approach was employed to review studies published systematically. Research was sourced from PubMed, ScienceDirect, and Google Scholar databases. Specific search terms related to CSOM and surgical treatments were used, and inclusion criteria focused on clinical, functional, and auditory outcomes. After a detailed screening process, 21 studies met the review’s criteria. Studies were categorised into surgical approaches, clinical outcomes, and functional/auditory outcomes. Surgical interventions such as tympanoplasty and tympanomastoidectomy were effective in resolving CSOM. The clinical outcomes highlight the fact that CWD mastoidectomy yields better disease control (85.7%) compared to CWU (76.6%) with a lesser amount of revision surgeries (42.1% vs. 57.9%); however, the latter demands long-term follow-up for cavities. Measures of functional results show tympanoplasty success in the 80-95% range, with CWU interfering with anatomy but having higher recidivism chances. Laser-aided tympanoplasty-driven reconstruction of the tympanic membrane yielded a success rate of 94.3 percent. Studies also suggest that tympanoplasty alone offered a mean своб gain of 9.41 dB, and tympanoplasty with mastoidectomy offered 12.05 dB. When added to the surgical methodology, laser-assisted surgery enhanced the air-bone gap reductions by over 20 dB (74.3%). Surgical interventions for COM significantly improve clinical, functional, and auditory outcomes, though success rates vary by technique. Further studies are needed to refine surgical protocols and optimise patient outcomes.