Mastoid Cavity Problems Research Articles

Postoperative mastoid cavity problems: a tertiary care centre experience

<p class="abstract"><strong>Background:</strong> Aims and objectives of the study were to find incidence and causes for postoperative mastoid cavity problems after modified radical mastoidectomy.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was conducted in the Department of ENT, SMGS Hospital, GMC Jammu from September 2017 to February 2020 on 25 patients with active squamosal chronic otitis media. All patients underwent modified radical mastoidectomy after taking written and informed consent. A period of 3 months postoperatively was taken as a healing time for complete epitheliasation of cavity. Any patient presenting with symptoms beyond this period was considered a cavity problem case.</p><p class="abstract"><strong>Results:</strong> Out of 25 patients, 9 patients had cavity problems, the incidence of cavity problem being 36%. Perforation in tympanic membrane was seen in 7 patients (77%) and high facial ridge in 2 patients (22%). There was no case of narrow meatoplasty in our study.</p><p class="abstract"><strong>Conclusions:</strong> Incidence of mastoid cavity problems can be reduced if the open cavity procedures are executed adequately.</p>

A prospective analysis of post mastoidectomy cavity complications

<p class="abstract"><strong>Background:</strong> The main aims of surgical treatment of chronic middle ear suppuration are elimination of disease process, reconstruction of hearing mechanism and prevention of complications. The objective of this study is to find out the incidence of cavity problems after open cavity mastoidectomy. To evaluate perioperative factors involved in the causation of cavity problems.</p><p class="abstract"><strong>Methods:</strong> A prospective analytical study was conducted among 78 patients came for open mastoidectomy admitted in department of ENT. Each patient had a follow up upto three months at twice weekly intervals. In this study a borderline healing period of three months (12 weeks) was given for the complete epithelialisation of an open mastoid cavity. SPSS was used for analysis. </p><p class="abstract"><strong>Results:</strong> The incidence of postoperative cavity problems in our set up is 26.92%. Youngest patient to undergo mastoidectomy was a 4-year-old boy. The youngest patient who presented with cavity problem was of 7years. 59 (75.64%) had sclerotic mastoid and 10 (12.82%) had cellular mastoid and 9 (11.53%) had diploeic mastoid. Hence out of the 21 postoperative mastoid cavity problems, 5 cases had large postoperative cavity, 18 cases had high facial ridge, 1 case had stenosis of meatoplasty, 17 cases had exposed middle ear and eustachian tube and 17 had postoperative granulations.</p><p class="abstract"><strong>Conclusions:</strong> There should be complete exenteration of disease from the middle ear and mastoid. An adequately lowered facial ridge is an essential step to attain a dry cavity.</p>

Mastoid cavity obliteration using bone pate and ribbon-like temporalis muscle flap: Our experience

Objective: The aim of this study was to elucidate a mix of bone pate with ribbon-like temporalis muscle flap for mastoid cavity obliteration after mastoid surgery to avoid mastoid cavity problems. Materials and Methods: In 54 patients of unsafe chronic suppurative otitis media, canal wall down mastoidectomy was done, size of the cavity assessed and ribbon-like temporalis muscle flap with bone pate used for mastoid cavity obliteration. Follow-up was done at 3 weeks, 3 months and then at 6 months. Results: Dry cavity with success rate of 83% is achieved with temporalis muscle flap technique of mastoid cavity obliteration. Conclusion: A mix of bone pate to obliterate the small spaces in the mastoid cavity along with a ribbon-like temporalis muscle flap is effective method of mastoid cavity obliteration as it gives a dry ear, is not bulky and most importantly maintains the canal.

The application of mastoidoplasty in repeated scanning operations on the ear

The objective of the present study was to evaluate the outcomes of mastoid obliteration with the use of the orthotopic bone tissue taken from the linea temporalis region. It was shown that this region is the optimal site at the temporal bone for the harvesting of the plastic bone material to be used in mastoidoplasty during secondary sanitizing surgical interventions on the patients with mastoid cavity problems after canal wall-down mastoidrctomy under conditions of the deficiency of the orthotopic bone tissue. The application of such tissue for the purpose of mastoid-obliteration surgery provides a number of advantages over other methods of mastoidoplasty, in the first place from the standpoint of tissue biocompatibility. Multispiral computed tomography (MSCT) of the temporal bones is a highly informative and non-invasive technique for the study and control of the patients' condition during the late postoperative period following a secondary sanitizing surgical intervention involving mastoidoplasty with the application of the orthotopic bone tissue.

Mastoid cavity obliteration with combined palva flapand bone pâté.

This study was designed to evaluate the usefulness of mastoid cavity obliteration with combined bone pâté and Palva flap in the prevention of problematic mastoid cavities after canal wall down mastoidectomy. In a prospective longitudinal study with a mean follow-up of 28 months conducted between 2008-2012, a series of 56 ears in 48 patients with chronic otitis media due to a cholesteatoma underwent canal wall down mastoidectomy that their mastoid cavity obliterated with combined bone pâté and Palva flap. Seventeen (30%) ears were managed via revision surgery, with the reminder via primary surgery. Data included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications. All patients underwent second-look surgery. Forty-six (82%) ears maintained a very small, dry and healthy mastoid cavity. Seven (13%) ears had occasional otorrhea, and three (5%) ears had small granulation tissue. Seven (12.5%) ears had residual cholesteatoma pearl in the middle ear at second-look surgery. Four (7%) ears exhibited wound infection. Canal wall down mastoidectomy and mastoid cavity obliteration with combined bone pâté and Palva flap is a effective option for the complete removal of cholesteatoma and prevention of postoperative mastoid cavity problems.

Avoiding mastoid cavity Problems: Mastoid obliteration using Bioactive glass

Background and objective: The aim of this study was to evaluate bioactive glass as an ideal material for the purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems. Materials and methods: In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical techniques according to pathology and situation during surgical exploration, basically adhering to standard principles of eradicating disease in chronic unsafe ear. After performing the canal wall down (CWD) or the canal wall up (CWU) technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form Bioglass®. Cases were divided according to operative procedures, type of reconstruction and material used into 3 groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass®. B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid cavity by particulate form Bioglass®. C- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass®. Results: Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction on the dura even with contact to Bioglass®. Infection was seen in 2 cases (10%), however was readily controlled by topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred. Conclusion: The successful formation of bone with elimination of mastoid cavity problems proved that using Bioglass is appropriate for performing clinical mastoid obliteration.

Anti-microbial and therapeutic effects of modified Burow's solution on refractory otorrhea

Burow's solution, which contains 13% aluminum acetate, has been shown to be effective against chronic otitis media. Since the preparation of Burow's solution is time-consuming, its rapid preparation method has been recently developed. In this study, we evaluated the therapeutic effects of the modified Burow's solution on refractory otorrhea in patients with chronic suppurative otitis and its anti-microbial activity in vitro. Fourteen ears of 12 patients with chronic otitis media, granular myringitis, otitis externa and postoperative mastoid cavity problems were treated topically with cotton swab/ball soaked with modified Burow's solution or its four-fold diluted ear drops once a week. We then examined the antimicrobial spectrum of modified Burow's solution against clinical bacterial isolates from otorrhea and laboratory bacterial strains in vitro. In all ears, refractory otorrhea disappeared after 1-17 weeks treatment of modified Burow's solution with a mean of 5.4 weeks without apparent side-effects such as ototoxicity. Modified Burow's solution inactivated all Gram positive bacteria within 5min except Enterococcus species, all Gram negative bacteria including Pseudomonas aeruginosa within 30s and Candida albicans within 2min. In addition, modified Burow's solution inactivated MRSA completely within 5min, while 80.6% of MRSA survived even a 20-min contact with 0.3% ofloxacin. These findings indicate that modified Burow's solution, in addition to bearing a broad antimicrobial activity, is as effective as the original Burow's solution in the treatment of chronic suppurative otitis.

難治性外耳道炎および中耳炎に対する４倍希釈ブロー液（迅速調整法）の臨床効果：原液との比較

We evaluated the effectiveness of quarter-strength rapid-preparation Burow’s solution for treating intractable chronic suppuration of the external ear canal and middle ear compared to nondiluted solution. Material was 32 ears of 24 subjects—12 men and 12 women—from aged 12 to 89 years with disease persisting from 1 month to 35 years. This consisted of chronic otitis externa in 8 ears, fungal otitis exrerna in 8, chronic otitis media with perforation in 8, postoperative mastoid cavity problems in 5, and chronic granulated myringitis in 3. Quarter-strength rapid-preparation Burow’s solution was dripped into the ear canal or small cotton balls soaked in the solution were applied. Overall, 17 (53%) of the 32 ears were cured and 10 (31%) were improved. Quarter-strength Burow’s solution showed almost the same effectiveness as non diluted solution, excluding the fact that it required frequent treatment. The piercing pain effects due to treatment was less (9%) than with the nondiluted solution (37%) and no case of tympanic perforation occurred, compared to one case seen in treatment with nondiluted solution. We recommend using quarter-strength rapid-preparation Burow's solution and avoiding direct use on the intact eardrum.

Surgical Outcomes In Children With Chronic Otitis Media

We reviewed our surgical techniques and outcomes of children with chronic otitis media (COM) who had underwent surgery. The surgical outcomes and techniques of 51 ear of 49 patients were analyzed retrospectively in the totally of 89 children, aged between 8 to 16 and underwent surgery for COM. On ear examination, 16 children had perforation, 14 children had polyp, 13 children had cholesteatoma. Tympanoplasty was performed in 43% (22 ears), tympanoplasty with mastoidectomy was performed in 56% (29 ears). The canal-wall up mastoidectomy (CWUM) was performed in 25% (13 ears), and canal-wall-down mastoidectomy (CWDM) in the remaining 31% (16 ears). Graft take rate was 76.84 % and hearing gain average was 10.2 dB. In the early period , recurrent and residual diseases are more frequently in the CWUM group than in the CWDM group. In the CWDM group, the mastoid cavity problems occurred more frequently than in the CWUM group. 14 children had polyp, 12 children had cholesteatoma and one child had Langerhans cell histiocytosis (LCH) on hystopathological examination in postoperative period. Not only the hearing loss was lower in children in preoperative period, but also the hearing gain was lower in chidren in postoperative period. The surgical outcomes of tympanoplasty with or without mastoidectomy in children are successful as the results of adults. We should not avoid to perform CWDM for the risks of recurrent and residual disease in children. LCH should be kept in mind for progressive COM in children.

難治性外耳道炎および中耳炎に対するブロー液（迅速調整法）の使用経験

We evaluated the effectiveness of Burow's solution prepared by the rapid preparation method for the treatment of intractable chronic suppurative disease of the external ear canal and middle ear.We examined 34 ears of 29 patients ranging from 1 to 84 years of age. There were 19 males and 10 females with disease persisting for a range of 1 month-50 years. The disease and number of ears were as follows; chronic granulated myringitis (8 ears), chronic otorrhea caused by ventilation tubes (6 ears), chronic otitis media with perforation (6 ears), chronic otitis externa (5 ears), postoperative mastoid cavity problems (5 ears) and fungal otitis exrerna (4 ears).Burow's solution prepared by the rapid preparation method was dripped into the ear canal for about 15 minutes or small cotton balls soaked with the solution were applied directly to the lesion.Overall, 19 (61%) of 31 ears were cured, 7 (23%) were improved. The newly developed Burow's solution showed almost the same effectiveness in the treatment of the chronic granulated myringitis and chronic otitis externa (67-100%), but was not effective for the treatment of chronic otitis media with perforation (33%).

The Effects of Basic Fibroblast Growth Factor on Postoperative Mastoid Cavity Problems

To present the effects of basic fibroblast growth factor on intractable cavity problems and discuss the mechanisms of its effects. We treated three ears with postoperative open cavities. All three cases had suffered from chronic discharge of the ear for 7, 10, and 30 years, respectively; 100 microg/ml of trafermin (genetic recombination) solution, as basic fibroblast growth factor, was dropped into the open cavity once daily. If bacterial and/or fungal infection was observed, antibiotics and/or antifungal agents were administered locally twice daily. The cavities epithelialized and were cured within 2 months using this treatment. Our results suggest that basic fibroblast growth factor stimulates the proliferation and differentiation of keratinocytes, fibroblasts, and endothelial cells, leading to accelerated wound healing. The basic fibroblast growth factor agent appears to be highly effective in treating intractable cavity problems.

Mastoid obliteration to prevent recurrent cholesteatoma

We have performed canal wall down tympanoplasty with mastoid obliteration as a fundamental surgical treatment for patients with acquired cholesteatoma for complete removal of the lesion and prevention of cholesteatoma recurrence. To avoid postoperative gap formation on the posterior canal wall, canal wall reconstruction using bone pate plate was performed after removal of both the anterior and posterior buttresses. Then the mastoid cavity was thoroughly obliterated with cortical bone slices to prevent the recurrent cholesteatoma. No recurrent lesion has been found on long-term observation after these procedures. Canal wall down tympanoplasty with mastoid obliteration is a useful technique for preventing recurrent cholesteatoma and postoperative mastoid cavity problems.

術後性乳突腔障害症例の検討

The open method is useful as a surgical technique for aural cholesteatoma or adhesive otitis media, but there are problems that arise from the opened mastoid cavity.Eighty-five ears with mastoid cavity problems, which had been operated on at our clinic from 1982 to 1991, were examined in this study. Earlier, One operation had been conducted on 52 ears, 2 on 24 ears, 3 on 7 ears, and 4 and 5 on 1 ear each. The average number of operations per ear was thus 1.5. The time since the first operation was 3 years and 4 months to 58 years and 1 month (average, 28 years and 11 months). The initial disease was chronic suppurative otitis media in 24 ears, aural cholesteatoma in 19, acute mastoiditis in 9 and unknown in 33.The main complaint of 62 patients was otorrhea. Thirty-four were found to have vestibular vertigo when the mastoid cavity was being cleaned. Only 8 labyrinthine fistulae were recognized during operation. In 45 ears the malleus was missing, in 51 ears the incus, and in 37 ears the stapedial super-structure.The mastoid was obliterated in 69 ears, bone chips were used in 50 ears and hydroxyapatite granules in 19 ears. The canal wall was reconstructed in 10 ears and revision operation was conducted in 6 ears. After mastoid obliteration, otorrhea was found in 6 patients, drum retraction in 6, and drum perforation in 2. In 31 of the 34 patients with vertigo there was good improvement after the operation. Hearing was generally not improved, especially in types 3 and 4 with ossicular reconstruction.

外耳道削除後の乳突腔に発生する諸問題

Mastoid cavity problems were studied in 113 ears that had the posterior canal wall removed during surgery (open tympanoplasty, radical mastoidectomy, modified radical mastoidectomy) for middle ear cholesteatoma. Posterior canal wall reconstruction with mastoid obliteration was performed in 19 ears, mastoid obliteration only in 10 ears, and no treatment for the open mastoid cavity in 84 ears.The total incidence of mastoid cavity problems was 30.1%. Aural discharge was most frequently observed (24.8%). Other problems included postoperative development of mastoid air cells, cholesteatoma or cyst formation, the absorption of the reconstructed canal wall, and mycosis. Cavity problems were more frequently observed in the groups with reconstruction or obliteration because of the absorption of those materials. Patients under 9 years old frequently had cavity problems, and additional surgery was performed in 44.1%.Preservation of the canal wall is most important in preventing the cavity problems, and firm obliteration of the open mastoid cavity with bone tissue or ceramics is necessary in patients that have the canal wall removed.

Tympanoplasty with mastoid obliteration using hydroxyapatite granules for aural cholesteatoma--a clinical and experimental study

Hydroxyapatite granules were employed for mastoid obliteration in cases of aural cholesteatoma. After eradicating a cholesteatoma by the canal-down technique, the canal wall was reconstructed with cortical bone chips, and the mastoid cavity was obliterated with hydroxyapatite granules. Tympanoplasty by this technique was performed on 48 ears with aural cholesteatoma. There was no recurrence of cholesteatoma during the follow-up period of two years after surgery. One case of residual cholesteatoma was found in the mesotympanum. There were two cases in which the hydroxyapatite granules became exposed through the posterior canal skin. An air-bone gap of less than 20 dB was achieved in 73% of all the patients. Experimental studies in guinea pigs have demonstrated that hydroxyapatite granules do not undergo morphological changes in and are tightly interdigitated with newly formed bone tissue growing from bulla bone one year after hydroxyapatite implantation in the temporal bullae. The newly-formed bone showed incomplete osteon structures. Excellent biocompatibility and bone adaptability of hydroxyapatite granules were demonstrated experimentally. It is concluded that tympanoplasty with mastoid obliteration using hydroxyapatite is safe and useful for avoiding mastoid cavity problems and for preventing the recurrence of cholesteatoma.

“HOW I DO IT” — Otology and neurology: A specific issue and its solution how to decrease postoperative mastoid cavity problems

“HOW I DO IT” — Otology and neurology: A specific issue and its solution how to decrease postoperative mastoid cavity problems