The Efficacy of Open Mastoidectomy Versus Mastoidectomy with Temporalis Fascia Flap Obliteration

Abstract

Objective To compare the efficacy of open mastoidectomy versus mastoidectomy with temporalis fascia flap obliteration in achieving postoperative dry ear chronic suppurative otitis media (CSOM) is a perforated tympanic membrane with persistent drainage of pus from the middle ear lasting more than 2-weeks. The global burden of illness from CSOM is estimated to involve about 65 to 330 million individuals with draining ears, 60% of them suffer from significant hearing impairment. Ninety (90) percent of burden is borne by developing countries, in Southeast Asia, the Western region of Africa. CSOM can occur with or without cholesteatoma, and the clinical history of both conditions can be very similar. The treatment plan for cholesteatoma always includes tympanomastoid surgery with medical treatment as an adjunct. The treatment plan for cholesteatoma always includes tympanomastoid surgery. After mastoidectomy the otologists facing mastoid cavity related problems such as otorrhoea, hearing loss. A variety of techniques have been proposed to perform obliteration. Methods Study design Randomized Controlled Trial. Setting Department of ear, nose, and throat (ENT), Head & Neck Surgery, Saidu Group of Teaching Hospital, Swat, Khyber Pakhtunkhwa, Pakistan. Duration of study From Jan, 2019 to 17 July, 2021. Sample size Randomly assigned patients with evidence of atticoantral disease to two groups, 47 in each group. After canal wall down mastoidectomy in Group A cavity left without obliteration, in Group B a superior based vascularized temporalis facial flap was used to obliterate the resultant mastoid cavity and they were followed up to 8-weeks. Results As per efficacy of both groups is concerned, in Group A, 34 (36.17%) patients had achieved post-operative dryness on 8th week of mastoidectomy whereas in Group B, 40 (42.55%) patients achieved post-operative dryness of ear on 8th week subject to mastoidectomy with temporalis fascia flap obliteration. (p value=0.130). Conclusion Patients who underwent mastoidectomy with temporalis fascia flap obliteration yielded better results in comparison to patients who underwent open mastoidectomy. Further the common organism were found in our region Staph Aureus and Bacteriodes and Proteus mirabilis.