Mastoid Surgery Research Articles

A Prospective Study Evaluating Indications & Outcomes of Revision Mastoid Surgery.

Mastoid surgeries are surgical procedures, wherein surgical failures are prevalent due to the fundamental complexities involved, especially in the understanding of microscopy and pathophysiology of the disease. A revision mastoidectomy is an utmost, a post-procedure decision, wherein the patient continues to exhibit signs and symptoms that are concerning. This is proved by a prospective, cross-sectional research which was conducted upon a group of patients who were referred to a tertiary health care centre. This selection of twenty-three (23) patients who underwent mastoidectomy prior to their participation in this research, were exhibiting signs of recurrent diseases. The observations of trends seen in revision mastoidectomy are detailed and inferences gleaned from it. These trends and observations direct us towards the understanding that the majority of failure of previous mastoidectomy was due to persistent diseased air cells and recurrent or residual cholesteatoma. This is further corroborated by the trends observed from exhausting literature readings of previous similar studies. Revision mastoid surgeries are an important follow-up process, after the mastoidectomy, if the patients continue to exhibit diseased states.

Noise exposure of the inner ear during robotic drilling.

Preserving the cochlear structures and thus hearing preservation, has become a prominent topic of discussion in cochlear implant (CI) surgery. Various approaches and soft surgical techniques have been described when approaching the inner ear. Robot-assisted cochlear implant surgery (RACIS) reaches the round window in a minimally invasive manner by following a trajectory of minimal trauma. This involves the drilling of a keyhole trajectory to the round window, through the facial recess, with no need for a complete mastoidectomy. It involves less drilling, less drilling time and less structural damage. A lot of attention has been paid to the structural traumatic causes of hearing loss but acoustic trauma during the exposure of the inner ear appears to be neglected topic. The aim was to measure the noise exposure of the inner ear during the robotic drilling of the mastoid and bony overhang of the round window. The results were compared with the milling in conventional cochlear implantation surgery. RACIS on fresh frozen human cadavers. The equivalent frequency-weighted and time-averaged sound pressure level LAF in dB and the noise dose in % derived from a noise damage model, both obtained during RACIS. The robotic drilling of 6 trajectories towards the inner ear were performed, including 4 trajectories through round window access and 2 trajectories through cochleostomy. The results were compared with the data of 7 cases of conventional CI surgery that have been described in literature. The induced equivalent sound pressure level LAF was determined via an accelleration sensor at the zygomatic arch and a calibration according to bone conduction audiometry. A noise dose for the whole procedure was calculated from the equivalent sound pressure level LAF and the exposure time using a noise damage model. A noise dose of 100% is considered a critical exposure limit and values above are considered potentially harmful, with the risk of hearing impairment. The maximum LAF was 82 dB during fiducial screw placement; 87 dB during middle ear access; 95 dB for the accesses through the round window and 88 dB for the accesses through cochleostomy. The noise dose due to the HEARO®-procedure was always far below the critical value of 100%. There was no acoustic trauma of the inner ear in all cases with the noise dose being smaller than 0.1% in five out of the six cases. The maximum LAF in the seven cases of conventional CI surgery was 118 dB with a maximum cumulative noise dose of 172.6%. The critical exposure limit of 100% was exceeded in three cases of conventional CI surgery. RACIS provokes significantly less acoustic trauma than conventional mastoid surgery in our findings. There were no observable differences in noise exposure levels between a cochleostomy or a round window approach where the bony overhang needed to be drilled.

The prevalence of facial canal dehiscence: first cross-sectional study in Iraq

BackgroundThe facial nerve is considered a crucial structure and is vulnerable to injury during middle ear and mastoid surgery. The facial canal could be dehiscent in certain populations; therefore, identifying it and avoiding injury to the nerve is an important step during otological surgeries. In this study, we assessed the rate of facial canal dehiscence (FCD) among patients undergoing surgery due to the presence of chronic suppurative otitis media (CSOM).MethodsA cross-sectional study was performed between June 2019 and May 2023. We included 102 patients (aged 8–70 years), admitted for primary tympanomastoid exploration due to the presence of CSOM with and without cholesteatoma at Azadi Teaching Hospital in Duhok/Iraq. Cases with a history of trauma or craniofacial abnormalities were excluded from the study. Also, none of the selected patients complained of facial nerve disorders.ResultsAmong the 102 patients who were admitted, 11.76% (n = 12) had FCD; they were between the ages of 11 and 58 (average: 30.9) years (18.8% ≤ 18 years vs. 10.5% > 18 years, p = 0.396). The dehiscence was more common in males than females (14.3% vs. 10.0%, p = 0.545) and was also more common on the left side than the right side (13.8% vs. 9.1%, p = 0.547). Of those with the dehiscent facial nerve, 83% (n = 10) had the dehiscence on the tympanic segment. The dehiscence was statistically more common in patients with cholesteatoma than those without (25.9% vs. 6.7%, p = 0.014).ConclusionDehiscence in the facial nerve can be encountered in patients with CSOM, particularly those with cholesteatoma. In such patients, the dehiscence is most commonly found on the tympanic segment of the facial nerve, so care should be taken during surgery for such cases to avoid injury of the nerve.

Revision mastoidectomy in a patient with unsafe Chronic Suppurative Otitis Media (CSOM): a case report

Background: Chronic suppurative otitis media (CSOM) with cholesteatoma can locally be destructive. Radical mastoidectomy is a procedure to clean and remove all cholesteatoma. However, there is a 38-60% chance of recurrence after the procedure, and the subsequent intervention is a more difficult and risky revision mastoid operation. In this study, we reported a 56-year-old woman with an unsafe type of CSOM who underwent revision radical mastoidectomy. Case Presentation: A 56-year-old woman presented with complaints of discharge accompanied by a hole in the left ear. The patient had previously undergone ear surgery about four years ago for similar complaints. Physical examination showed a full ear canal on the left with secretions, and the tympanic membrane was difficult to assess. A head CT scan result was suggestive of chronic mastoiditis with cholesteatoma. The patient was treated with revision radical mastoidectomy and had a good outcome. Conclusion: In conclusion, this case report presents a 56-year-old woman with recurrent unsafe type CSOM who underwent revision mastoidectomy and had a good outcome. Causes of surgical failure include a high facial ridge and inadequate meatoplasty.

PRIMARY TUBERCULAR OTITIS MEDIA PRESENTING AS BEZOLD’S ABSCESS WITH FACIAL NERVE PARALYSIS

Introduction: Tuberculosis of the middle ear cleft is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult. Material & Methods: Here we present 14 years old, case of malnourished male with a history of poor immunisation and contact TB in neighbourhood was admitted in our hospital in December 2023 with right ear otorrhea, hearing loss, fever with Bezold’s abscess post aurally and peripheral facial nerve paralysis.Ear Discharge was from childhood, the recent episode of fever with post aural swelling developed over 1 week. Examination of right ear showed copious amount of mucopus which was cleaned to visualise granulation tissue with retracted tympanic membrane Conclusion: Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods. Keywords: tubercular, otitis media, facial paralysis, Bezold’s abscess, mastoidectomy

Spontaneous Cerebrospinal Fluid Leak Presenting as Middle Ear Effusion Caused by Arachnoid Granulations

While middle ear effusion (MEE) is a common ailment in children with Eustachian tube dysfunction, it occurs less frequently in adults. In such cases, a meticulous assessment is essential to discern the underlying cause of MEE. We present an unusual case of spontaneous cerebrospinal fluid (CSF) leak attributed to arachnoid granulation presenting as MEE. A 59-year-old obese female presented with right ear fullness, reduced hearing, and a persistent postnasal drip for 2 years. Audiological testing shows unilateral mild-to-moderate conductive hearing loss in the right ear. Tympanometry assessment revealed a persistent type B pattern in the right ear, indicating persistent unilateral conductive hearing loss. However, despite receiving treatment with nasal decongestants and antihistamines for 2 weeks, no signs of improvement were observed. Subsequently, a right myringotomy and grommet insertion were performed, resulting in the drainage of clear watery fluid that persisted for 2 weeks. A high-resolution computed tomographic scan of the temporal bone revealed the right MEE, bony defect in the right tegmen tympani, and bony irregularities of both tegmen tympani. Magnetic resonance imaging unveiled herniation of the right inferior temporal lobe through the identified tegmen defect. The patient subsequently underwent cortical mastoidectomy, lateral skull base repair, and mastoid obliteration. The histopathological examination of the biopsy taken from the right middle ear tissue revealed fragments of glial tissue with small fragments of trabeculae, which were confirmed by the positivity of the glial fibrillary acidic protein stain. The patient has remained asymptomatic for 10 months following the operation, and her hearing has fully returned to normal. It is advisable to consider CSF effusion as a potential differential diagnosis, particularly among adults aged over 50 years, even in the absence of a history of head trauma, mastoid surgery, or meningitis, when confronted with persistent unilateral MEE.

Diagnostic Accuracy of Plain Computed Tomography Temporal Bone in Detection of Pre-operative Ossicular Status versus Per-operative Findings in Chronic Otitis Media.

Ossicular destruction is a common phenomenon in chronic otitis media due to an imbalance between osteoblasts and osteoclasts. Computed tomography helps us in the assessment of ossicular status, extent of pneumatization, and early identification of complications. This study aims to check the diagnostic accuracy of computed tomography temporal bone for the detection of ossicular erosion in comparison with the surgical findings taken as a gold standard. The use of this investigation as an adjunct can prove to be helpful in planning mastoid exploration as well as a primary reconstruction surgery especially in mucosal and early squamosal diseases. It's a cross-sectional validation study done on 50 patients with chronic otitis media (both mucosal and squamous type) from July 2022 to November 2023. Patients underwent CT scanning of temporal bone and ossicular status was reported by the radiologist. Later on, mastoid surgery was carried out and per operative findings were documented. 2 × 2 tables were formed and diagnostic accuracy of CT temporal bone was checked in terms of sensitivity, specificity, negative predictive value, and positive predictive value. The results revealed that CT temporal bone has a high diagnostic accuracy with a sensitivity of 92.5% and specificity of 100% for malleus (p value < 0.001). For incus and stapes, sensitivity came out to be 93.5% and 76% respectively and specificity values were 94.7% and 100% (p value < 0.001 for all) giving a verdict that the pre-operative use of this radiological investigation should be encouraged by otologists.

Specialist consensus on endoscopic surgery of the middle ear mastoid

This article discusses otoscopic middle ear mastoid surgery from multiple perspectives. Firstly, it discusses the indications and contraindications for surgery from the nature of the lesion and the imaging manifestations; secondly, it recommends the applicable equipment and describes the surgical approach in detail; finally, it summarizes the principles of the management of the operative cavity of the mastoid process in the middle ear from the perspectives of function and reconstruction. The purpose of this article is to illustrate otoscopic middle ear mastoid surgery with the aim of providing reference or guidance for performing related surgeries.

150 years ago: Schwartze's 1873 mastoidectomy and its implementation over the following 2years.

In 1873, Hermann Schwartze and Adolf Eysell described anew surgical technique for treating mastoid disease using amallet, chisels, and gouges of various sizes instead of trephines or drill instruments also called "modern mastoidectomy." On the 150th jubilee of this landmark article, we pay tribute by studying the reception and implementation of mastoidectomy in the 2years following its publication. The commentaries published in the otological and medical literature between the second part of 1873 to the end of 1875 were studied with an emphasis on the three specialized otological journals and the otological textbooks that existed during this period. The princeps paper Ueber die künstliche Eröffnung des Warzenfortsatzes ("On the artificial opening of the mastoid process") by Hermann Schwartze and Adolf Eysell published in 1873 was rapidly disseminated in the medical literature for nearly 1year, and then entered aphase of evaluation followed by aphase of extension and implementation, before finding its definitive place in the history of mastoid process surgery.

Complications of Mastoid Surgery: A Descriptive Study from a Tertiary Care Centre, Assam, India

Complications of Mastoid Surgery: A Descriptive Study from a Tertiary Care Centre, Assam, India

Evaluation of inner ear damage by mastoid drilling with measurement of serum prestin (SLC26A5) levels

ObjectiveThe objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. MethodsThe patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. ResultsIn both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. ConclusionOur results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. Level of evidenceLevel-4.

Comparative Analysis of Various Materials Used for Mastoid Cavity Obliteration in Canal Wall Down Mastoid Surgery.

To study the surgical result and efficacy of different methods of mastoid obliteration with cavity care. This prospective study included 60 patients who had cholesteatoma, conducted in the Department of Ear Nose and Throat (ENT), Institute of Medical Sciences, Banaras Hindu University, Varanasi from July 2015 to July 2017. The mastoid cavity was obliterated with either muscle flap/bone dust/hydroxyapatite. detailed history otoscopic examination was done pre-operatively and follow up were recorded at 1month and 3months in postoperative period. 60 patients were included, who underwent canal wall down mastoid surgery. each group muscle flap (group 1), bone dust (group 2) and hydroxyapatite (group 3) included 20 patients, age group 31-40year with its maximum incidence of 43.3%, Preop PTA value were almost equal in all group but on comparison at 1month in postoperative period significant improvement was present in group 1 versus 2(0.021) and group 2 versus 3(0.003) but not in group 1 versus 3. Although at 3month there were significant improvement was present in all groups. The incidence of pain, discharge, giddiness and wax formation were markedly reduced and healing of cavities was early and better in obliterated cavities done by muscle flap and bone dust material as compared to hydroxyapatite cavities, at the end of 3months. outcome and quality of life was better and almost equal in muscle flap and bone dust material group as compared to hydroxyapatite group.

Predictive Factors for Subjective Vertigo Following Cochlear Implantation: A Regional Multicenter Cohort Study of 395 Patients.

Cochlear implantation (CI) is generally accepted as having a low rate of postoperative complications, but between 9.3% and 13% of cases experience vertigo postoperatively. This study aimed to examine patient, surgical, and device factors contributing toward the risk of postoperative vertigo. A retrospective review was conducted of adult patients who underwent cochlear implant in a regional area of New South Wales from 2007 to 2018. A total of 395 cochlear implant cases were included in the final study. The overall incidence of vertigo at 3 months of follow-up was 7.1% (n = 28/395). No difference was identified in this study between rates of postoperative vertigo between device factors, including implant make (Cochlear vs. Med-El), electrode shape (perimodiolar vs. straight), and electrode model. No significant difference was found also for surgical factors such as the number of electrode rings inserted, side of implantation, or surgical approach of tympanic ramp (round window insertion vs. cochleostomy).A higher percentage of patients with preoperative vertigo experienced vertigo postoperatively (18.4%, n = 7/38), compared with the population without preoperative vertigo (6.0%, n = 21/352) (p = 0.005). Patients with previous mastoid surgery also reported a higher rate of postoperative vertigo (20%, n = 9/45) compared with those who had not had mastoid surgery (5.43%, n = 19/350) (p = 0.006). The mean age of patients experiencing postoperative vertigo was higher than the population without postoperative symptoms (67 vs. 63). This study of a large multicenter population outlines that patient factors are more critical than surgical or device factors when considering risk factors for vertigo post-cochlear implant.

Osteoma

Osteoma is a benign osteoblastic mesenchymal tumor consisting of differentiated mature bone tissue. Ear canal osteoma is an osteoma that occurs in the external acoustic canal. Osteoma of the ear canal is usually asymptomatic, but several symptoms that can accompany a total occlusion of the external acoustic canal are vertigo, tinnitus, which can also cause recurrent otitis externa, otorrhoea and otalgia. Mr. S came to the ENT Poly at Cut Meutia Hospital with complaints that his left ear felt blocked since 1 year ago. hearing loss in left ear. Left ear often bleeds when prying. Sometimes the patient feels pain in the left ear, and a clear, odorless discharge comes out of the left ear. The patient's left ear is often buzzing.&#x0D; On examination the local physical status found a solid mass, immobile, stalked, and unilateral and had closed all of the left external auditory canal. The tuning test found conductive deafness in the left ear. The patient was planned for CT-Scan Mastoid and osteoma excision surgery.

Analysis of hearing outcome following canal wall up and canal wall down mastoidectomy in squamosal type of chronic suppurative otitis media: A comparative study

Background: Chronic suppurative otitis media (CSOM) is a major health issue in developing countries causing persistent problem and may lead to life-threatening complications. This major health issue and its complications can be best avoided by early and effective treatment. Aims and Objectives: The aim is to compare the outcome in terms of hearing improvement following canal wall up and canal wall down mastoid surgery. Materials and Methods: This prospective study was conducted in Otorhinolaryngology Department of a Burdwan Medical College and Hospital, Burdwan, a tertiary care hospital in Burdwan from April 2019 to August 2020 and 50 clinically diagnosed cases of COM (Squamous type) were included in this study after through history taking and meticulous clinical examination. Patients were divided in two Groups (Group-A and Group-B) with 25 patients in each group randomly and Group-A patients undergone canal wall up mastoidectomy and Group-B patients undergone canal wall down mastoidectomy (CWDM). Now, before performing surgery, a pre-operative pure tone audiometry was performed for each of the patients and a follow-up pure tone audiometry was done again, 2-month post-operative period. These results were compared to assess the degree of hearing improvement in the two different operative procedures, namely, canal wall up and CWDM. Results: In Group-A, the mean hearing gain (mean±SD) of patients was 12.5700±0.9856. In Group-B, the mean hearing gain (mean±SD) of patients was 8.4200±5.0051. Difference of mean hearing gain with both groups was statistically significant (P=0.0002). Chi-square value: 0.1678; P=0.9195. Conclusion: Hearing gain was more with canal wall up compared to CWDM in CSOM which was statistically significant.

The effect of pneumococcal conjugated vaccines on occurrence of recurrent acute otitis media among infants diagnosed with acute otitis media at an age younger than 2months.

To examine the impact of pneumococcal conjugate vaccines (PCV) on the occurrence of recurrent acute otitis media (rAOM) among infants diagnosed with an early acute otitis media (AOM) episode. Retrospective cohort study of pediatric patients with a first episode of AOM at an age < 2months. Data included clinical, demographic, and microbiological findings at the first AOM episode. In addition, a 5-year follow-up after the patient's first episode was completed from the medical records. This information included documentation of rAOM episodes and complications of AOM (hearing loss, speech disturbance, mastoiditis, and tympanic membrane perforation) and of ear-related surgical procedures (ventilation tube placement, adenoidectomies, and mastoid surgery). Two groups were studied: patients diagnosed between 2005 and 2009 (representing the unvaccinated group, group 1) and those diagnosed in 2010-2014 (the vaccinated group, group 2). A total of 170 infants were diagnosed with a first AOM episode at an age < 2months; 81 of them belonged to group 1 and 89 to group 2. Streptococcus pneumoniae was isolated in the middle-ear fluid in the first AOM episode in 48.1% of the patients in group 1 and in 30.3% in group 2 (P = 0.0316). 49/81 (60.5%) infants in group 1 were diagnosed with rAOM versus 39/80 (43.8%) in group 2 (P = 0.0298). No statistical differences were found between the groups with respect to long-term complications or need for surgery later in life. Conclusion: Our study showed a significant decrease in the occurrence of rAOM in infants diagnosed with AOM during the first 2months of life and timely immunized with PCVs following this initial AOM episode. What is Known: • 30% of children experience recurrent AOM (rAOM) at the first year of life. The earlier the age of the first AOM, the greater the risk for future complications. • After the introduction of PCVs, the overall pneumococcal AOM incidence declined. We investigated the future effect of PCVs on rAOM occurrence, when administered after the first AOM episode. What is New: • A retrospective cohort of 170 infants with a first AOM episode at an age <2 months and followed for 5 years, showed a significant decrease (28.0%) of rAOM in immunized infants following the initial AOM episode. • Our findings supplement previous data suggesting that the widespread PCVs use prevents rAOM by preventing early AOM and emphasize the importance of timely administration of the PCVs.

A case series of cholesteatoma spread in middle ear cleft

Background: This study aimed to describe the spread of cholesteatoma in middle ear cleft. Methods: The 20 patients diagnosed with chronic otitis media, squamosal type (cholesteatoma) who underwent mastoidectomy exploration were included in this study. The main emphasis was to find out the extent and spread of cholesteatoma into the middle ear cleft. Results: The result of the study showed 50% of cases spread to middle ear cavity (20% -meso tympanum, 15%-sinus tympani,15%-facial recess), 20% into the attic, 30% into adits, antrum and mastoid air cell system. Conclusions: All of our patients underwent mastoid exploratory surgery. In half of the cases, the cholesteatoma was restricted to middle ear cavity, while in remaining 50% it has extended to attic, aditus mastoid antrum and mastoid air cells. Disease clearance was effective with no post-operative complication or recurrence in first 50% cases. Other 50% of cases required extensive surgery for disease clearance.

Quality of life after mastoid surgery. Is there a real benefit to preserving the posterior wall of the external auditory canal? A systematic review and meta-analysis.

ObjectiveCanal wall up (CWU) and canal wall down (CWD) mastoidectomies represent the most common cholesteatoma surgical techniques. In this meta-analysis, we compare the postoperative quality of life (QoL) in patients treated with either CWU or CWD mastoidectomy. MethodsA literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and data were extracted independently by two authors. Biases assessment was conducted for each study according to the Methodological Items for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed for postoperative QoL following CWU versus CWD mastoidectomy. ResultsOur systematic review included four studies that met the inclusion criteria, three prospective cohort studies, and one retrospective cohort study. The meta-analysis did not favor treatment with one of the two surgical techniques. Postoperative QoL did not show a statistically significant difference between CWU and CWD mastoidectomies (p>0.05). ConclusionOur systematic review and meta-analysis results indicate that QoL is not statistically significantly better among patients who underwent CWU mastoidectomies when compared with CWD. The trend of selecting CWU over CWD mastoidectomies in selected cases - for QoL purposes - is not always based on evidence-based data. The statistically insignificant difference between the two surgical techniques suggests that an initial more radical approach might prevent patients from further surgeries, without affecting postoperative QoL.

Does drilling affect the hearing of contralateral normal ear after mastoid surgery?

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) is a recurrent infection of the middle ear and/or mastoid air cells affecting 2-3% of global population. Mastoidectomy is the mainstay of the treatment of COM. Bone drilling during mastoidectomy procedure exposes both the ears to acoustic trauma leading to sensorineural hearing loss. The present study was conducted to assess the possible deleterious effect of drilling on hearing of contralateral normal ear by monitoring pre-operative and post-operative pure tone audibility (PTA) and otoacoustic emissions (OAE). Aims and objectives were to evaluate the effect of drill- generated noise on hearing in non-operated ear during mastoidectomy in terms of hearing loss, its nature and duration and recovery of hearing loss.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An observational study was carried out in ENT department at SMS medical college and hospital, Jaipur. Total 40 patients were studied. Pre-operative and post-operative PTA and OAE were studied and compared. Mean drilling time during mastoid surgery was also studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 40 subjects, maximum patients were 11-20 years of age group (37.5%) with female preponderance (57.5%). All had undergone mastiodectomy. Only 6 (15%) subjects had transient sensorineural hearing loss of contralateral normal ear as determined by comparing pre-operative and post-operative PTA and OAE. The mean recovery time was 2-3 days. The study had shown significant effect of drill generated noise on hearing of contralateral healthy ear following mastoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Drill-generated noise can’t be lowered to a great extent therefore drilling time should be minimized during mastoid surgeries.&lt;/p&gt;

Audit of Middle Ear Surgery Outcomes in a Tertiary Referral Australian Teaching Hospital.

This study aimed to audit middle-ear surgical procedures, provide a record of Australian experiences and allow comparisons with other published audits. A retrospective continuous series audit was conducted on 274 patients who underwent tympanoplasty, mastoidectomy and stapedotomy surgery at Westmead Hospital, Sydney. All consecutive surgical procedures, performed by multiple operators at various stages of training but under the care of a single surgeon, were included. Graft uptake was 86.9 per cent in tympanoplasty. Well healed cavities were seen in 72 per cent of mastoidectomies. Although 42 per cent of the patients had one or more co-morbidities, this did not influence the outcome. Hearing improvement was dramatic in stapedotomy and minimally changed in mastoidectomy. Post-operative complications were minimal. All forms of middle-ear surgery were effective in achieving their surgical goals. Aural discharge and inflammatory diseases were well controlled with tympanoplasty and mastoid surgery.