Pursuing a flexible approach to tympanomastoidectomy: Benefits of a tailor-made strategy in squamosal otitis media

Abstract

Introduction: The keystone of definitive management in active squamosal chronic otitis media (COM) is surgical correction. Numerous surgical strategies are in vogue, and the choice of surgery is largely governed by the underlying anatomic and pathologic condition. Of recent, much interest has focused on adopting a flexible approach which combines a number of sequential steps that aim to eradicate the disease and reconstruct the hearing apparatus in a single stage procedure, rather than following a traditional approach of modified radical mastoidectomy. Patients and Methods: This randomized, prospective double-blind study comprised 30 patients of various ages and both sexes, diagnosed with a unilateral or bilateral active squamosal chronic otitis media (COM). Of them, 12 (40%) patients were submitted to canal-wall down mastoidectomy, whereas 18 (60%) underwent a canal-wall up procedure. Each patient was followed up for a period of 6 months. The success of the procedure was measured in terms of achieving dry ear; a successful uptake of graft; and improvement in hearing. Results: Post surgery, at the end of 6 weeks, a dry ear was achieved in 25 (83.33%) patients, while the graft was taken up well in 29 (96.67%) patients. At 6 months, the number of patients with dry ear grew to 27 (90%), while the graft was taken up well in 28 (93.33%) patients. Two (6.66%) patients had graft failure. Of the 12 patients with canal-wall down procedure, 9 (75%) patients recorded a hearing improvement of air bone gap (ABG) ≤30 dBHL, while among the 18 patients who had a canal-wall up procedure, 94% had a hearing improvement of ABG ≤ 30 dBHL. Conclusion: Pursuing a flexible approach to tympanomastoidectomy offers a number of distinct benefits. Because the procedure is tailored to the gravity of otologic disease recognized intraoperatively, it fosters a total eradication of the disease and allows a suitable reconstruction of the auditory mechanism. Because the procedure is completed in a single stage, it reduces the time, effort, cost, and discomfort to the patient, while also diminishing the expense and burden on the public healthcare facility.