Abstract
Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope. The study was done to assess and clean postoperative canal wall down mastoidectomy cavities with endoscope and compare with oto-microscopy. This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant. The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely. Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.
Highlights
Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery[1] which can lead to a chronically discharging cavity, frustrating the patient as well as the operating surgeon
The level of cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 obtained by Fisher extract test
Canal wall down mastoidectomy with reconstruction of hearing mechanism and adequate meatoplasty is one of the chosen methods for treating such a condition
Summary
Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery[1] which can lead to a chronically discharging cavity, frustrating the patient as well as the operating surgeon. Thomassin and colleagues in 1987 in France devised the first endoscopically guided otosurgery in the prevention of residual cholesteatoma. This landmark article showed a considerable reduction in residual cholesteatoma attributed to the advent of endoscopic evaluation of blind spots encountered during the primary surgery.[2].
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