Modified radical mastoidectomy in children: mastoid cavity problem and its management

Abstract

<p class="abstract"><strong>Background:</strong> Various factors are responsible for post MRM chronically discharging mastoid cavity which has to be identified and treated properly so as to avoid further complications. The aim of this study is to evaluate the causative factors responsible for persistent ear discharge in post mastoidectomy cases and their management in paediatric age group.</p><p class="abstract"><strong>Methods:</strong> This is a cross sectional study done from May 2013 to April 2017 in the Paediatric ENT unit of Department of ENT & HNS, TUTH, Kathmandu, Nepal. Children were evaluated for persistent ear discharge and managed for one year. Risk factors like high facial ridge, inadequate meatoplasty, unepithelize mastoid cavity, tympanic membrane perforation and residual or recurrent choleateatoma, infections, nasal or nasopharngeal pathology were evaluated and treated. Outcome of management was measured in terms of achieving dry mastoid cavity over one year period. </p><p class="abstract"><strong>Results:</strong> A total of 92 post MRM children with persistent discharge were included in the study. 33/92 (35.8%) had anatomical defects. Four cases had recurrent or residual cholesteatoma. 22/92 (23.9%) of the cases had granulation and infection. 14 cases had nasophayngeal inflammation and 13 cases had recurrent accumulation of wax or debris. After the treatment of various factors, 43/75 (53.7%) ear became dry within 3 months, 22/75 (29%) ear became dry within 6 months, 6/75 had persistent discharge even 1 year after treatment. Whereas, in 5/75 (13.4%) had on and off discharge.</p><p class="abstract"><strong>Conclusions:</strong> The chronically discharging mastoid cavity can be well managed by early identification of causative factors.</p>