Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life

Nora M Weiss,Robert Mlynski,Wilma Großmann,Jannik Botzen,David Bächinger

doi:10.1007/s00405-020-05881-4

Abstract

ObjectiveTo assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration.MethodsPatients who had undergone canal wall-down mastoidectomy for chronic otitis media with creation of a persistent mastoid cavity and underwent revision tympanomastoid surgery including mastoid cavity obliteration using autologous material were included. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air–bone gap (ABG) were assessed. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively.ResultsA total of 25 patients (16 females and 9 males; mean age 51.6 years, 14 right and 11 left ears) were included. Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. Compared to the preoperative visit, patients showed a significantly reduced AC PTA at the postoperative visit (mean difference: − 4.1; SD = 10.4, p = 0.045). The mean ZCMEI-21 score changed from 31.7 (SD = 14.5) preoperatively to 17.4 (SD = 15.1) postoperatively (mean difference: − 14.3; SD = 19.1; p = 0.0002). The mean ZCMEI-21 score changes were neither correlated to the AC PTA shift (p = 0.60) nor to the ABG shift (p = 0.66).ConclusionsThis is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. The improvement in HRQoL was not correlated to the hearing improvement. As a clinical implication, we provide evidence for a substantial subjective benefit of the surgical obliteration of a symptomatic mastoid cavity and, therefore, encourage this surgical procedure.

Highlights

In extended inflammation processes of the middle ear and mastoid, an open mastoid cavity was created without reconstruction under the aim of draining the disease into the bony outer ear canal [1]
health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration has never been studied in a prospective setting using a disease-specific HRQoL instrument
Whereas two studies reported a subjective benefit from surgery [25, 26], another study reported a majority of patients experiencing no change in quality of life after mastoid obliteration [27]

Summary

Introduction

In extended inflammation processes of the middle ear and mastoid, an open mastoid cavity was created without reconstruction under the aim of draining the disease into the bony outer ear canal [1]. In cases of a persistent mastoid cavity, symptoms such as chronic ear discharge, ear pain, and hearing impairment may severely impair patient’s health-related quality of life (HRQoL). HRQoL in patients undergoing mastoid cavity obliteration has never been studied in a prospective setting using a disease-specific HRQoL instrument. Whereas two studies reported a subjective benefit from surgery [25, 26], another study reported a majority of patients experiencing no change in quality of life after mastoid obliteration [27]. The aim of this study was to systematically investigate the change in HRQoL in patients undergoing mastoid cavity obliteration in a prospective setting using a disease-specific instrument

Study design and patient selection

Results

Discussion

Conclusion

Compliance with ethical standards