Mastoid Cavity Research Articles

Transmastoid Repair of Otogenic Encephaloceles in Patients With Canal Wall Down Mastoidectomy.

Description of a series of cases in which otogenic encephaloceles in patients requiring canal wall down (CWD) mastoidectomies were repaired via a transmastoid approach. Case series. Tertiary-care hospital. Eleven cases of otogenic encephaloceles in patients requiring CWD mastoidectomy for chronic ear disease. Surgical repair of an otogenic encephalocele using a transmastoid approach. Success of repair, number and size of defects, materials used for repair, complications encountered in surgery, pure tone average air-bone gap (PTA-ABG). Eleven cases were identified. Two of these patients had a prior CWD cavity while the remainder received CWD mastoidectomy simultaneously with encephalocele repair. None of the patients required revision of encephalocele repair. Mean preoperative PTA-ABG was 30 dB and mean postoperative PTA-ABG was 28 dB (p = 0.66). A single-stage strictly transmastoid approach to otogenic encephalocele repair may be effective in patients with prior CWD mastoid cavities or requiring concurrent CWD mastoidectomy for chronic ear disease and/or cholesteatoma.

Comparison of Outcomes of Open Mastoid Cavity- with or Without Obliteration.

For a chronically discharging ear open mastoidectomy is the mainstay of treatment, however it can cause high morbidity due a large cavity and complications like discharge, vertigo and difficulty with hearing aids. To avoid such problem, obliteration of mastoid cavity is done. The objective of our study was to compare the post-operative complains, the hearing results and outcomes of open and closed mastoid cavity. The present prospective study was conducted on 40 patients having attico-antral disease in middle ear cleft. Patients were randomly divided into two groups of 20 each. Out of 40 patients, in 20 patients (Group A) mastoid obliteration was done using conchal cartilage, whereas in other 20 patients (Group B) canal wall down mastoidectomy without mastoid obliteration was done i.e.an open cavity. The patients were followed up post-operatively at 6th week, 3rd month and 6th month. Study Design: comparative study. On Pure Tone Audiometry, 13 (65%) patients with closed mastoid cavity had Air-bone Gap < 30dB, 7 (35%) were in the range 30-60dB as compared to open mastoid cavity where 10 (20%), 8 (40%), 2(10%) patients had ABG < 30db, 30-60dB, and > 60dB respectively, showing better hearing results in obliterated cavities, healing was also better. In obliterated mastoid cavities, there were very few complications of pain, discharge, and giddiness compared to open cavities. Healing as shown by epithelisation was earlier and better in obliterated cavities. Hearing results were better in mastoid cavities with obliteration compared to open cavities. Patients with obliterated mastoid cavity need less cavity care and doctor dependence.

Effects of mastoid and middle-ear volume on graft success and hearing outcomes in paediatric tympanoplasty.

To examine the effects of mastoid and middle-ear volume on the anatomical and functional success of type 1 tympanoplasty in paediatric patients. This study included 45 paediatric patients who underwent type 1 cartilage tympanoplasty. Patients' demographic data, pre- and post-operative audiological evaluation results, and post-operative graft status were evaluated. Middle-ear and mastoid cavity volumes were calculated (in cubic centimetres) using temporal bone high-resolution computed tomography. Middle-ear and mastoid cavity volume values were compared between patients with and without post-operative anatomical and functional success. Anatomical success was achieved in 82.2 per cent of patients (n = 37), and functional success in 68.9 per cent (n = 31). When anatomical success and failure groups were compared, a statistically significant difference was found in mean mastoid volume (p = 0.037), while there was no significant difference in relation to mean middle-ear volume (p = 0.827). The comparison of functional success and failure groups revealed no significant difference in mean mastoid volume (p = 0.492) or middle-ear volume (p = 0.941). The study showed that mastoid pneumatisation volume affects surgical success in paediatric tympanoplasty.

Microbial flora of mastoid cavity after canal wall down (CWD) mastoidectomy

Introduction: Many scientists have worked on microbial flora of the ear canal or middle ear in nonoperated patients, but it is not clear that what changes would be occurred in the flora of the mastoid cavity postoperatively. It can help the surgeons to choose the appropriate drugs in the perioperative period. The study was designed to investigate the microbial flora of the middle ear and mastoid cavities after canal wall down (CWD) mastoidectomy. Materials and Methods: The survey was designed as a prospective cross-sectional study. All patients with chronic otitis media who had undergone CWD mastoidectomy in a public university hospital from 2014 to 2017 were enrolled in the study. They were periodically followed up postoperatively at least for 6 months. Swab sampling from ear cavity was performed, and the samples were sent for culture and antibiogram. Each specimen was sent for bacterial and fungal analysis. If bacterial culture result was positive, the sensitivity of the cultured organisms to common antibiotics was also assessed. Results: Seventy-four patients entered into the survey. Twenty-six (35%) of samples were positive for bacteria, and 11 (14.5%) were positive for fungi. Furthermore, 3 (4%) of the studied ears were positive simultaneously for both bacterial and fungal culture. Among cultured bacteria, Staphylococcus epidermidis was the most common species (29%). Candida species was the most common fungal species (8%). Conclusions: Microbial infection is a common finding after CWD mastoidectomy. S. epidermidis and Candida species should be considered as the primary targets of treatment.

Mastoid obliteration during last 5 years

The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.

What is the impact of mastoid surgery on swimming?

Swimming confers significant physical and mental health benefits to people but there is little evidence regarding the impact of mastoid surgery on this activity. Almost half of the patients (46.7%) swim less after mastoid surgery. Occasional swimmers are affected mostly. The need to protect the ear and dizziness are the main reasons to discontinue swimming. Acute incapacitating vertigo occurs in 8.9% patients during swimming. No difference in swimming frequency between patients with a closed or an open mastoid cavity was observed. The presence of a wet ear after surgery and the use of prophylactic measures did not affect the swimming frequency. Patients should not be discouraged from swimming on the basis of mastoid surgery. We recommend a trial of swimming with or without protection in shallow waters first, under the supervision of an experience swimmer.

CAVITY PROBLEMS AND THEIR MANAGEMENT IN POST MODIFIED RADICAL MASTOIDECTOMY IN PEDIATRIC POPULATION - A CLINICAL AUDIT

Objective: To find out the intensity and frequency of cavity problems of persistent and recurrent ear discharge in young children and their management in post Modified Radical Mastoidectomy (MRM).&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Department of ENT Head &amp; Neck Surgery, Lady Reading Hospital MTI Peshawar Pakistan, from Jan 2015 to Dec 2019.&#x0D; Methodology: Fifty-four patients with cavity problems of persistent and recurrent ear discharge needing treatment were included in the study (out of the total patients 234 operated upon). Patients were followed up for one year for any discharge of the mastoid cavity. Patients of both gender of age 15 years or younger were included in the study.&#x0D; Results: In this study the cavity problems were found in 23.1% (54 out of 234) of the post modified radical mastoidectomy in pediatric population. There were no surgery related problems in 61.1% patients. In 38.9% (21 out of 54) percent patients repeat mastoidectomy was performed. Where as in 37% (20 out of 54) excision of granulation and conservative management was sufficient in curing the disease. High facial ridge was found to be the most common cause of persistent/recurrent discharge 9 out of 54 (16.7%). The independent variables (Indications for repeat mastoidectomy, Factors causing discharge, Surgery related problems) support the dependent variable treatment outcome. The sig/p-value was zero therefore the result was significant.&#x0D; Conclusion: In post Modified Radical Mastoidectomy, the cavity can be dry provided meticulous care is given to complete exenteration of disease from all areas........

Study of Clinical Profile and Comparison of Various Dimensions of Chronic Otitis Media among the Adult and Paediatric Population from Rural Area

Background: The term Chronic Suppurative Otitis Media (CSOM) is characterized as "chronic middle ear and mastoid cavity infection, which occurs through tympanic membrane perforation with recurrent ear discharge or otorrhoea . Though there are many similarities between adult and pediatric CSOM in terms of disease progression and pathological changes, there are certain notable differences stemming from temporal bone anatomy and extent of pneumatization, the immaturity of Eustachian Tube in terms of its function and variable progression of disease. Pediatric temporal bone being more pneumatized makes the disease to spread more extensively. Childhood cholesteatoma has much greater rates of residual and recurrence disease than seen in adults. This study is aimed to compare various dimensions of CSOM among the paediatric and adult age group in rural population.&#x0D; Methods: This cross-sectional comparative study is scheduled from November 2020 to November 2023 in ENT Department of AVBRH, Wardha. Total 50 patients with chronic Otitis Media in the paediatric and adult age group will be enrolled. Baseline investigations will be performed for all patients and compared.&#x0D; Expected Results: Clinical profile and behavior of chronic otitis media in adult and paediatric population in rural areas will be outlined, emphasizing middle ear changes, grade and extent of retraction pockets and cholesteatoma respectively. Pneumatization of the temporal bone and audiological status will be reported.&#x0D; Conclusion: Differentiating characteristics of chronic otitis media in adult and paediatric population with specified features will be concluded.

Modified Canal Wall Down Mastoidectomy Without Meatoplasty

It is important to decide which procedure to employ between canal wall up mastoidectomy and canal wall down mastoidectomy (CWDM) as each procedure has its own advantages and disadvantages. To combine the advantages and compensate the disadvantages of each procedure, various methods and approaches have been devised. Mastoid and epitympanic obliteration, which minimizes the dead space in the mastoid cavity, was previously known to prevent the occurrence of retraction pockets. We performed mastoid and epitympanic obliteration also to prevent the occurrence of cavity problems without meatoplasty. Here we describe the surgical procedures for modified CWDM without meatoplasty and mastoid obliteration using autologous materials.

Study of ossicular chain defects in patients with chronic otitis media

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) is a long-standing disease of middle ear cleft and mastoid cavity having a permanent perforation in the tympanic membrane with or without discharge. It’s a worldwide health problem and it is still predominant in the modern antibiotic era. Aim&lt;strong&gt; &lt;/strong&gt;was to determine the prevalence and types of ossicular chain defect in mucosal and squamosal type of COM. Also, to evaluate the hearing loss in relation to ossicular chain defect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was prospective observational study conducted in Bhopal over the duration of one year (January 2019 to June 2020). Patient aged 11-70 years reporting with COM were included in the study. Details regarding sociodemographic profile and extensive examination were recorded. Data was entered into MS excel 2007, analysis was done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; It was more prevalent in the age groups of 21-30years (39%) with female (53%) preponderance. Right sided ear was commonly involved (58%). Majority of the patients had tubo-tympanic disease (62%) whereas 38% had attico-antral disease. Ossicular chain was found intact in 33% cases. Average hearing loss was maximum (67.6 dBHL) when all ossicles are eroded. Hearing loss was minimum (33.6 dBHL) with isolated handle of malleus involvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; COM is one of the commonest causes of preventable hearing impairment in our society, hence early diagnosis and timely intervention is needed. Awareness among patients and doctors regarding the need for better ear hygiene is necessary.&lt;/p&gt;

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

PurposeTo evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction.MethodsThis is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing.Results79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques.ConclusionWe show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

Correlation between Intraoperative Ossicular Status and Conductive Hearing Loss Degree among Chronic Suppurative Otitis Media Patients in Dr Mohammad Hoesin General Hospital Palembang

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucosa and periosteum of the middle ear and mastoid cavity that defined as a perforated tympanic membrane with persistent drainage for more than 2 months. Preoperative hearing threshold and air bone gap (ABG) assessment are expected to predict the ossicular status which can only be ascertained intraoperatively. This study aimed to determine the correlation between intra-operative ossicular status and the degree of conductive hearing loss assessed based on the hearing threshold and average ABG among CSOM patients in RSUP Dr. Mohammad Hoesin Palembang.&#x0D; Methods: Observational research using a cross sectional design. The data were collected using medical record on 64 subjects with a diagnosis of CSOM who underwent mastoidectomy surgery at Dr. Mohammad Hoesin Hospital Palembang for the period of March 2019 to June 2021.&#x0D; Results: From 64 samples conducted in the study, the average ossicular status score in CSOM patients was 1.84 ± 1.48, with the highest group scoring 0 being the malleus incus and intact stapes as many as 21 patients (31.3%). There was a strong positive correlation between hearing threshold scores and intra-operative ossicular status scores (p&lt;0.005, R=0.5) and there was a strong positive correlation between ABG scores and intra-operative ossicular status scores (p &lt;0.005, R=0.6). From the linear regression test, the most influential in predicting intra-operative ossicular status scores were gender, hearing threshold value, ABG value, and the presence of cholesteatoma&#x0D; Conclusions: There is a significant relationship between intra-operative ossicular status and the degree of conductive hearing loss in CSOM patients.

The effect of fascia and free skin graft on the healing of mastoid cavity after canal wall down mastoidectomy.

Post-mastoidectomy delayed cavity healing is a challenge to manage. This study aimed to cut down healing time with a simple technique (fascia with a skin graft) and compared it with controls without this technique. The current study was a prospective non-randomised controlled study, conducted in a tertiary referral hospital. Thirty cases and 30 controls with squamosal type chronic otitis media were studied. By the end of first month, 23.3 per cent of cases had healed compared with 3.3 per cent of controls. At the third month follow up, 83.3 per cent of cases and 53.3 per cent of controls had healed. At the sixth month follow up, 93.3 per cent of cases and 86 per cent of controls had healed. Healing of the mastoid cavity, as evidenced by epithelialisation and formation of a dry cavity, was faster in cases that received the graft when compared with controls without the graft.

Surgical treatment of dumbbell-shaped jugular foramen schwannomas via two-piece lateral suboccipital approach: Report of 26 patients

BackgroundDumbbell-shaped jugular foramen schwannomas (JFS) are rare but challenging for the treatment. Surgical resection is believed to be the optimal therapy; however, postoperative dysfunction of the lower cranial nerves (CNs), tumor residual, cerebrospinal fluid (CSF) leakage, and subcutaneous hydrops are common. The current study's objectives were to describe the optimal surgical strategies for the total removal of dumbbell-shaped JFS, the functional preservation of lower CNs, and the prevention of postoperative CSF leakage. Methods26 consecutive patients with dumbbell-shaped JFS were surgically treated between January 2014 and June 2019. All patients were operated on via two-piece lateral suboccipital approach, vascularized muscle flap was used for the repair of the dural defect after an operation. The clinical information and radiological data of these patients were retrospectively reviewed, and the optimal surgical strategies were further evaluated and discussed. ResultsThe tumor was completely removed in all 26 patients, one patient developed new CN Ⅶ paralysis, and 2 developed new CN IX and Ⅹ paralysis after an operation, all patients were significantly relieved during follow up. None of them developed subcutaneous hydrops and postoperative CSF leakage. No tumor recurrence was observed during a mean follow up of 38.8 (16–69) months. ConclusionsDumbbell-shaped JFS could be safely and completely removed via the two-piece lateral suboccipital approach. Postoperative CSF leakage could be effectively prevented by careful repair of the dural defect in the jugular foramen (JF) and filling the mastoid cavity with a vascularized muscular flap.

Mastoid cavity obliteration with bone dust: a retrospective study of 34 cases

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic suppurative otitis media leads to ear discharge with hearing loss with squamosal type often presents with cholesteatoma and mainstay of treatment is surgical. Modified radical mastoidectomy is the ideal surgical option in these cases but it results in open mastoid cavity formation with certain common cavity problems. This study done to find the results of mastoid cavity obliteration with autologous bone dust and how this technique is effective in avoiding long term cavity problems and assists in ossiculoplasty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective observational study done in a tertiary care hospital. Patients presented with squamosal type of chronic otitis media were operated for a canal wall down modified radical mastoidectomy.The mastoid cavity was obliterated using bone dust. A follow up of the patients was done and the healing of the cavity with the hearing result assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study includes total of 34 patients. 58.82% were male and 41.18% were female. All patients underwent canal wall down modified radical mastoidectomy and obliteration of the mastoid cavity was done with bone dust. The common cavity problems of discharge, debris were markedly reduced in an obliterated cavity with better healing of the cavity. The middle ear aeration was maintained assisting the ossicular reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study showed that mastoid cavity obliteration with bone dust offers significant long term benefits in providing dry, well epithelized cavity at the same time assisting in ossicular reconstruction.&lt;/p&gt;

Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy.

ObjectiveTo prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used.MethodsIn this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome.ResultsThe time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow‐ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported.ConclusionSilicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy.Level of Evidence4.

Bioactive glass in canal wall reconstruction tympanoplasty

The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.

Mastoid Obliteration Using Bioactive Glass—Our Experience

Abstract Aims The aim of this study was to evaluate the surgical outcome of cavity obliteration with bioactive glass in patients with cholesteatoma undergoing canal wall down mastoidectomy with reconstruction of the canal wall. Materials and Methods A prospective study was conducted over a period of 3 years on 25 patients who underwent mastoid obliteration with bioactive glass following canal wall down mastoidectomy for cholesteatoma. The primary outcome measure was the presence of a dry, low-maintenance mastoid cavity that was free of infection, assessed, and graded according to the grading system by Merchant et al at the end of 1 and 6 months postoperatively. Secondary outcome measures included presence of postoperative complications like wound infection, posterior canal wall bulge, and residual perforation. Results Out of the 25 patients on whom this study was conducted, at the end of 1 month 60% had a completely dry ear, 28% of patients had grade 1, and 12% had grade 2 otorrhea at the end of the first month. At the end of 6 months, 72% had a completely dry ear, while 20% had grade 1 and 8% had grade 2 otorrhea. There were no cases with grade 3 otorrhea during the entire follow-up period. Postoperative complications of the posterior canal bulge were noted in two patients (8%), and one patient (4%) had a residual perforation. Conclusion Mastoid cavity obliteration with bioactive glass is an effective technique to avoid cavity problems.

A case study of post-auricular persistent mastoid cutaneous fistula closure by anteriorly based temporalis muscle flap and tempero-mastoid fascio-cutaneous-periosteal flap

&lt;p class="abstract"&gt;Post-auricular cutaneous mastoid fistula (PAMCF) is a rare complication of chronic otitis media (COM), following complicate mastoid surgery and very rarely following congenital cholesteatoma. The failure rate with simple closure is high due to necrotic skin edges. Therefore several techniques for the closure of this fistula have been described. Post aural fistula after canal wall down (CWD) mastoidectomy can be successfully treated by fistula tract excision and obliterating the mastoid cavity. A 45 year old woman presented with discharging PAMCF, 10 years following radical mastoidectomy surgery. It was due to non-compliance of the patient, as she had not gone for follow up for 10 year following radical mastoidectomy. The temporo-mastoid fascio-cutaneous-periosteal advancement flap is effective for proper closure of the fistula and obliteration of the cavity by conchal cartilage along with anteriorly based vascularised pedicled temporalis muscle flap to ensure the viability of the flap and preventing the necrosis of the skin edges, henceforth the recurrence of the fistula.&lt;/p&gt;

A novel view of computed tomography images similar to the visual field of otologic surgeons.

ObjectivesIn preparation for endoscopic sinus surgery (ESS), the most important computed tomography (CT) image for otolaryngologists is the coronal plane image because it has a viewpoint similar to that of the surgical visual field. Contrastingly, otologic surgeons refer to axial and coronal plane images before ear surgery and must imagine the anatomical structure of the temporal bone by reconstructing three‐dimensional (3D) images in their minds. We propose a “surgical position view (SPV) image,” a novel viewpoint of CT images that enables otologic surgeons to see a perspective similar to the surgical visual field.MethodSagittal plane CT images of the temporal bone were created from axial plane images with multi‐planar reconstruction (MPR). Then, the SPV image was obtained by rotating it 90° to the supine position. The entire process can be performed anywhere in the hospital within 1 minute using the electronic medical record computer's image viewer.ResultsSPV images show anatomical structures of the temporal bone, external ear canal, mastoid cavity, sigmoid vein, facial nerve, ossicles, and cochlea, in a similar view to the actual ear surgery. Soft tissue such as cholesteatoma is depicted in the same concentration as the normal CT image.ConclusionThe SPV image enables an otologic surgeon to see the temporal bone CT image from the actual ear surgery viewpoint simply and quickly. It helps to visualize the 3D anatomical structure of the temporal bone and can be useful for ear surgery planning.Level of evidence5