Outcome of Tympanomastoidectomy in Children with Chronic Otitis Media

Abstract

Objectives: Analyze outcomes of tympanomastoidectomy for chronic otitis media in children at a tertiary care referral center with a high prevalence of patients with genetic syndromes, craniofacial anomalies, and medical comorbidities. Methods: A retrospective review of tympanomastoidectomy performed for chronic otitis media at a single pediatric tertiary care hospital from 1995 through 2013 was performed. Factors evaluated included presence of immunodeficiency or craniofacial anomaly, change in air-bone gap and speech reception threshold, and need for additional otologic procedures. Results: Fifty-six tympanomastoidectomies on 47 patients were evaluated. A total of 25% of the children had a genetic syndrome and 17% had an immunodeficiency. Average age at surgery was 7.5 years with an average duration of follow-up of 2.7 years. Previous treatment included prolonged oral antibiotics (43), prolonged intravenous antibiotics (11), and middle ear irrigation and exchange of tympanostomy tube (7). Twenty-nine ears had undergone 2 or more tympanostomy tube insertion. A total of 28 (50%) ears continued to have some otorrhea postoperatively. Complete audiologic data were available for 23 patients. Improvement in air-bone gap was seen in 87% of cases, with an average improvement of 11.9 dB ( P = .01). Improvement in speech reception threshold was seen in 65%, with an average decrease in threshold of 10 dB ( P = .27). Of the cases, 8.9% required revision tympanoplasty following tympanomastoidectomy. Conclusions: Tympanomastoidectomy in children with severe chronic otitis media improves hearing function and may be beneficial in some patients to cease otorrhea. This should be considered as a treatment option in children that have failed previous conservative management.