Mastoid Surgery Research Articles

Time trend analysis of mastoidectomy procedures performed in Ontario, 1987–2007

Conclusions: There has been a reduction in the number of modified radical mastoidectomy and revision mastoidectomy surgeries per head of population in Ontario between 1987 and 2007, we believe that this represents a true reduction in prevalence of cholesteatoma. The increase of cases performed at the University Hospital Network, Toronto (UHN) may represent a shift to subspecialization in the treatment of chronic ear disease. Objective: To analyze the trends in mastoid operations for chronic middle ear disease in the Canadian province of Ontario between 1987 and 2007 and to determine whether an increasing proportion of these procedures are being performed in tertiary referral centres. Methods: The year on year population and number of mastoid procedures performed per year in Ontario and at the UHN between 1987 and 2007 were obtained from Statistics Canada and the Ministry of Health and Long-Term Care, Ontario, respectively. Population-adjusted rates of mastoid surgery for Ontario and the UHN. These data were collated and graphically represented for trend analysis. Results: The population-adjusted number of mastoid procedures for Ontario declined from 7.1 cases per 100 000 in 1986 to 4.1 cases per 100 000 in 2006. During this time the number of both modified radical mastoidectomies and revision mastoid surgeries at UHN increased.

Face and Content Validation of a Virtual Reality Temporal Bone Simulator

To validate the VOXEL-MAN TempoSurg simulator for temporal bone dissection. Prospective international study. Otolaryngology departments of 2 academic health care institutions in the United Kingdom and United States. Eighty-five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5-point Likert-type scale. A score of 4 was the minimum threshold for acceptability. The experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P = .01). User-friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P = .01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand-eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P = .01). Transferability of skills to the operating room was undecided (mean score 3.5). Realism of the VOXEL-MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual-spatial perception during deeper temporal bone dissection, are warranted.

Taste disturbance after mastoid surgery: immediate and long-term effects of chorda tympani nerve sacrifice

To determine the immediate and long-term taste effects of chorda tympani nerve sacrifice in patients undergoing open cavity mastoidectomy. A retrospective, questionnaire survey of patients receiving follow up and aural toilet following open cavity mastoidectomy, over a four-month period. The questionnaire assessed taste disturbance, both immediately post-operative and current. Available surgical records were reviewed for chorda tympani references. Of 57 patients, six had undergone surgery to both ears. Of those who could recall (37/57), 24.3 per cent were aware of taste disturbance immediately after surgery, while 8.7 per cent reported current disturbance (median post-operative interval, 28.5 years; range, one month to 67 years). No bilateral surgery patients were aware of taste disturbance. Mastoidectomy consent procedure emphasises the risk of hearing loss and facial nerve injury, yet in open cavity surgery chorda tympani division is almost inevitable. Reassuringly, most post-operative taste disturbance resolves, and most patients are not aware of long-term disturbance. However, a small percentage suffer ongoing taste disturbance; this could be significant for professional chefs and wine-tasters. The risk of taste disturbance should be addressed in the consent procedure.

Toward safer practice in otology: A report on 15 years of clinical negligence claims

To determine the characteristics of medical negligence claims arising from otological practice. Retrospective analysis of medical negligence claims contained in the National Health Service Litigation Authority (NHSLA) database. Claims relating to otology and neurotology between 1995 and 2010 were obtained from the NHSLA database and analyzed for cause of injury, type of injury, outcome of claim and costs. Over 15 years there were 137 claims in otology, representing 26% of all the claims in otolaryngology. Of these, 116 have been closed, and 84% of closed claims resulted in payment. Of the 97 successful claims, 63 were related to operative complications. This included six cases of wrong side/site surgery, and 15 cases of inadequate informed consent. The most common injuries claimed were hearing loss, facial paralysis, and additional/unnecessary surgery. Middle ear ventilation and mastoid surgery were the procedures most commonly associated with a successful claim. There were 15 successful claims of misdiagnosis/delayed diagnosis, with chronic suppurative otitis media the condition most frequently missed. There were nine successful claims related to outpatient procedures, of which seven were for aural toilet and six claims of medical mismanagement, including three cases of ototoxicity from topical medications. There were also four successful claims for morbidity due to delayed surgery. This is the first study to report outcomes of negligence claims in otology. Claims in otology are associated with a high success rate. A significant proportion of claims are not related to surgery and represent areas where safety should also be addressed.

Inner Ear Effects of Canal Wall Down Mastoidectomy: A Prospective Study

Objective: Evaluate the inner ear effects of canal wall down (CWD) mastoidectomy in the treatment of chronic otitis media (COM) in regard to bone conduction hearing and reported tinnitus and dizziness related disability. Method: Prospective study of 86 consecutive patients treated by CWD mastoidectomy for COM with or without cholesteatoma. Patients underwent preoperative audiogram and completion of 2 surveys: Dizziness Handicap Inventory (DHI) and Tinnitus Handicap Inventory (THI), which were repeated 4 to 6 months postoperatively. Results: No significant change in bone-conduction hearing scores occurred postoperatively. DHI and THI scores improved in the vast majority of patients. Thirteen patients, 13 out of 34 (38%), had DHI improvement greater than 18 points, indicating a significant patient-perceived improvement in dizziness-related disability. Sixteen patients, 16 out of 43 (37%), had THI improvement greater than 20 points, indicating a significant patient-perceived improvement in tinnitus-related disability. Three patients developed new-onset postoperative dizziness, and 5 patients developed new-onset postoperative tinnitus. The odds ratio for improving DHI and THI scores relative to or worsening scores is 6.6 in DHI (95% CI: 1.8 to 25.0) and 4.2 in THI (95% CI: 1.45 to 12.2). Conclusion: Canal wall down mastoidectomy did not result in new-onset sensorineural hearing loss. In addition, using the Dizziness Handicap Inventory and Tinnitus Handicap Inventory measures, patient-perceived disability from dizziness and tinnitus was shown to decrease after mastoid surgery.

The value of non-echo planar HASTE diffusion-weighted MR imaging in the detection, localisation and prediction of extent of postoperative cholesteatoma

To evaluate the diagnostic performance of half-Fourier-acquisition single-shot turbo-spin-echo (HASTE) diffusion-weighted magnetic resonance imaging in the detection, localisation and prediction of extent of cholesteatoma following canal wall up mastoid surgery. Prospective blinded observational study. University affiliated teaching hospital. Forty-eight patients undergoing second-look surgery after previous canal wall up mastoid surgery for primary acquired cholesteatoma. All patients underwent non-echo planar HASTE diffusion-weighted imaging prior to being offered 'second-look' surgery. Radiological findings were correlated with second-look intra-operative findings in 38 cases with regard to presence, location and maximum dimensions of cholesteatoma. Half-Fourier-acquisition single-shot turbo-spin-echo diffusion-weighted imaging accurately predicted the presence of cholesteatoma in 23 of 28 cases, and it correctly excluded in nine of 10 cases. Five false negatives were caused by keratin pearls of <2 mm and in one case 5 mm. Overall sensitivity and specificity for detection of cholesteatoma were 82% (95% confidence interval [CI] 62-94%) and 90% (CI 55-100%), respectively. Positive predictive value and negative predictive value were 96% (CI 79-100%) and 64% (CI 35-87%), respectively. Overall accuracy for detection of cholesteatoma was 84% (CI 69-94%). Half-Fourier-acquisition single-shot turbo-spin-echo diffusion-weighted imaging has good performance in localising cholesteatoma to a number of anatomical sub-sites within the middle ear and mastoid (sensitivity ranging from 75% to 88% and specificity ranging from 94% to 100%). There was no statistically significant difference in the size of cholesteatoma detected radiologically and that found during surgery (paired t-test, P = 0.16). However, analysis of size agreement suggests possible radiological underestimation of size when using HASTE diffusion-weighted imaging (mean difference -0.6 mm, CI -5.3 to 4.6 mm). Half-Fourier-acquisition single-shot turbo-spin-echo diffusion-weighted imaging performs reasonably well in predicting the presence and location of postoperative cholesteatoma but may miss small foci of disease and may underestimate the true size of cholesteatoma.

Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma

The purpose of this study is to evaluate the efficiency of conservative dilute vinegar therapy in the management of spontaneous external auditory canal cholesteatoma (EACC). From 2000 to 2007, 19 patients presented to our clinic with spontaneous EACC. EACC was divided into four grades based on the temporal bone computed tomography: grade I with flattening of bony external canal, grade II with partial destruction of inferior bony canal, grade III with total destruction of inferior bony canal and grade IV with bony destruction into the middle ear and mastoid cavity. Clinical findings and treatment results were recorded. Microscopic local cleansing and dilute vinegar therapy was conducted in the ears with grades I, II and III. Combined mastoid surgery and dilute vinegar therapy was conducted in four ears with stage IV. There were no recurrences after average of 31 months follow-up. Spontaneous EACC can be effectively controlled with dilute vinegar therapy after microscopic local cleansing. However, surgery must be considered in the cases which have involved the mastoid and middle ear. Dilute vinegar therapy in combination with microscopic local cleansing was effective in the management of spontaneous EACC. Dilute vinegar therapy is an easy, cost-effective, and home-based cleansing method to prevent EACC and promotes healing. However, long-term follow-up may reveal frequent recurrence of cholesteatoma debris and involvement of middle ear or mastoid cavity, and then meticulous debridement with skin graft or surgical intervention should be considered.

Microanatomical study of the area in which the facial nerve being easy to damage in mastoid surgery

Objective To study the microanatomy of the area in which the facial nerve being easy to damage in mastoid surgery, in order to provide microanatomical datas for the clinical works. Methods In 20 adult wet skull specimens (40 temporal bones), the segments of facial nerve and their adjacent structures in the area in which the facial nerve being easy to damage were observed according to operation of mastoid surgery. Results The length of the horizontal segment was (8.85 ± 1.01) mm (7.10-11.25 nun), the diameter was (1.88 ± 0.65) mm (1.55-1.90 mm); The angle opening towards anterior direction between horizontal segment and vertical segment was (115.50 ± 6.89°) (109.5°-128.6°); The vertical distance from the cochlearform process to this segment was (1.89 ± 0.58) mm (0.90-3.05 mm); The vertical distance from the midpoint of the base of stapes to this segment was (1.92 ± 0.52) mm (1.44-2.56 mm); The vertical distance from the head of the stapes to this segment was (2.30 ± 0.85) mm (1.97-3.11 mm); The angle towards posterior direction between horizontal segment of facial nerve and tympanic tegmen was (28.5°± 3.66°) (25.8°-31.5°); The diameter of the pyramidal segment of facial nerve was (1.89 ± 0.65) mm (1.56-1.88 mm); The distance between the su mmit of pyramidal segment of facial nerve and the apex of shor limb of incus was (2.55 ± 0.21) mm (2.10-2.90 mm); The distance from the su mmit to the eminence of the lateral semicircular canal was (2.86 ± 0.31) mm (2.23-3.56 mm); The diameter of the proximal part of vertical segment of facial nerve was (2.13 ± 0.13) mm (1.90-2.40 mm); The angle towards superior direction between verical segment of facial nerve and chorda tympani nerve was (38.60 ± 1.99°) (28.5°-52.5°); The vertical distance from the top of the pyramidal eminence to the vertical segment of the facial nerve was (2.05 ± 0.65) mm (1.85-2.36 mm). Conclusions The eminence of the lateral semicircular canal, short limb of incus, cochlearform process, tympanic tegmen, stapes, pyramidal eminence, chorda tympani nerve in the area are important landmarks to be located in mastoid surgery. The anatomic relations in this area are complicated and compact. Anatomical knowledge is very important to the surgery of this area. Key words: Facial nerve; Mastoid; Microanatomy

A Guideline in Reporting Hearing Results in Middle Ear and Mastoid Surgery (2000)

A Guideline in Reporting Hearing Results in Middle Ear and Mastoid Surgery (2000)

Evaluating the effectiveness of the Voxel-Man TempoSurg virtual reality simulator in facilitating learning mastoid surgery

The Chief Medical Officer's 2008 annual report highlighted the importance of simulation in medical training. Simulator development has focused on increasing authenticity and fidelity. Development has not necessarily been guided by evidence for educational improvement. On reviewing 34 years of literature, Issenberg et al identified ten features of high-fidelity medical simulators that facilitate learning. This study compares cadaveric temporal bone (CTB) simulation with the Voxel-Man TempoSurg (VT) virtual reality simulator in addressing these features. A questionnaire was designed comparing the VT with CTB. Fourteen trainees and six consultants completed the questionnaire after using the simulator. The VT is better at allowing repetitive practice, ease of control of difficulty, and capturing clinical and pathological variation. The VT is as good as CTB in curriculum integration, allowing multiple learning strategies, providing a controlled environment, individualising learning and defining benchmarks. It appears worse with regards to face validity and feedback. Virtual reality simulation and CTB have features that allow effective learning. Some of these are common to both, in some CTB is better and in others virtual reality is better. Virtual reality could be a significant mode of learning supplementary to CTB and experience in the operating theatre.

Evaluating the effectiveness of the Voxel-Man TempoSurg virtual reality simulator in facilitating learning mastoid surgery

INTRODUCTION The Chief Medical Officer's 2008 annual report highlighted the importance of simulation in medical training.1 Simulator development has focused on increasing authenticity and fidelity. Development has not necessarily been guided by evidence for educational improvement. On reviewing 34 years of literature, Issenberg et al identified ten features of high-fidelity medical simulators that facilitate learning.2 This study compares cadaveric temporal bone (CTB) simulation with the Voxel-Man TempoSurg (VT) virtual reality simulator in addressing these features. SUBJECTS AND METHODS A questionnaire was designed comparing the VT with CTB. Fourteen trainees and six consultants completed the questionnaire after using the simulator. RESULTS The VT is better at allowing repetitive practice, ease of control of difficulty, and capturing clinical and pathological variation. The VT is as good as CTB in curriculum integration, allowing multiple learning strategies, providing a controlled environment, individualising learning and defining benchmarks. It appears worse with regards to face validity and feedback. CONCLUSIONS Virtual reality simulation and CTB have features that allow effective learning. Some of these are common to both, in some CTB is better and in others virtual reality is better. Virtual reality could be a significant mode of learning supplementary to CTB and experience in the operating theatre.

Case Report: Open Mastoidectomy and temporalis flap in the control of chronic otorrhoea

Open mastoid surgery still remains a principal operative treatment for chronic discharging ear. The indications for this procedure still abound in the tropics although it is rarely done in the developed countries nowadays. This series re-emphasize the control of chronic otorrhoea and operative wound infection as benefiting from a combined open mastoidectomy and reconstruction with deep temporalis fascia flap in children. The operative technique is further discussed. It is our hope that repopularising this procedure will help in the control of highly prevalent chronic ear in the tropical environment.

Transtemporal management of temporal bone encephaloceles and CSF leaks: Review of 56 consecutive patients

Conclusions: This report details our experience in the management of 56 consecutive patients with mastoid encephaloceles and cerebrospinal fluid (CSF) leaks. The majority were managed through the transmastoid route with temporalis fascia and calvarial bone graft. Among the patients operated on at least 18 months before analysis, there was a median follow-up of 54 months with no intracranial complications. The average body mass index (BMI) of patients with spontaneous CSF leaks was found to be statistically significantly greater than that of patients with CSF leaks with traumatic, infectious or iatrogenic etiologies. Objectives: To investigate the long-term follow-up of patients with spontaneous, iatrogenic, and traumatic temporal bone encephaloceles and CSF leaks to determine the effectiveness of the repair, late intracranial complications, and recurrent lesions. Methods: This is a retrospective review from a tertiary care center of 56 consecutive patients managed with CSF otorrhea, encephaloceles, and spontaneous pneumocephalus. All patients were repaired through transtemporal, middle cranial fossa or combined approaches for extradural repair and bone grafting. Results: Of the 56 consecutive cases, 12 had CSF otorrhea alone, 19 had encephaloceles, and 23 had both. Two patients presented with spontaneous pneumocephalus without CSF leak. Thirty-three patients had spontaneous onset of their lesion without any history of temporal bone surgery or trauma. The average BMI of patients with spontaneous CSF leaks was found to be greater than the average BMI of patients with CSF leaks due to traumatic, infectious or iatrogenic causes. This difference was found to be statistically significant. Six of these had either preceding or subsequent contralateral mastoid or anterior fossa (sphenoid, ethmoid) CSF leak. Intracranial pressure was evaluated in these cases and most underwent VP shunting to reduce their intracranial pressure. Sixteen cases followed previous mastoid surgery or chronic ear disease and seven were attributed to previous temporal bone trauma. Lesions were repaired with the transtemporal approach (42), middle fossa (4), and combined (5) approaches. Five cases required petrosectomy and fat obliteration. There was one recurrent CSF leak 4 years after initial repair; the leak was anterior to the previously placed bone graft.

Retraction: Systematized Intraoperative Facial Nerve Monitoring in Middle Ear and Mastoid Surgery; 'Surgical Dehiscence' and 'Electrical Dehiscence'

The following original article from Korean Journal of Otolaryngology-Head and Neck Surgery, “Systematized Intraoperative Facial Nerve Monitoring in Middle Ear and Mastoid Surgery; ‘Surgical Dehiscence’ and ‘Electrical Dehiscence” by Yun-Hoon Choung, published on March 2006 has been withdrawn from publication by agreement among the authors, the journal Editor, Sung Won Chae, and the publisher ML communications Co., Ltd. The retraction has been agreed due to substantial overlap of the content of this article with previously published one. The author and the Journal apologize to readers.

Delayed Facial Nerve Paralysis after Tympanomastoid Surgery: The Potentiality of Fungal Infection and Treatment

Received December 24, 2010 Revised April 5, 2011 Accepted April 6, 2011 Address for correspondence Hyong Ho Cho, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Chonnam National University Medical School, 671 Jebong-ro, Dong-gu, Gwangju 501-746, Korea Tel +82-62-220-6772 Fax +82-62-228-7743 E-mail victocho@hanmail.net Background and ObjectivesZZThe purpose of this study was to assess the clinical courses and clinical outcomes of delayed facial nerve paralysis (DFNP) after middle ear and mastoid surgery. Subjects and MethodZZIn our hospital, postoperative DFNP occurred in 13 cases among the patients who underwent ear surgery from December 2000 to February 2010. During the same period, another 4 cases with postoperative DFNP were diagnosed at a local clinic. We assessed the degree of DFNP by using House-Brackmann grade (HBG) and separated 8 patients in grade II, 6 patients in grade III and 3 patients in Grade IV. Among 17 patients, DFNP occurred after open cavity mastoidectomy in 11 cases and after closed cavity mastoidectomy in the rest of 6 cases. ResultsZZAmong 17 postoperative DFNP, fungal infections were found in three patients. Patients for whom antifungal agent was relatively delayed in application, their condition did not improved. ConclusionZZAfter treatment, most of patients recovered within 1 month and there were no other associated infection during hospitalization. We suggest that antifungal agents should be used as soon as possible when patients complain about DFNP following open cavity mastoidectomy. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:324-8

Acute mastoiditis in the pneumococcal vaccine era

Introduction and objectivesAcute mastoiditis is the most common complication of acute otitis media. Recent studies have noticed an increase in cases. The goal of this study was to review acute mastoiditis cases diagnosed in children younger than 14 years old. Material and methodsA retrospective study of all patients under 14 years old admitted with a diagnosis of mastoiditis between 1996 and 2008 was performed. Epidemiological, laboratory and clinical variables were analysed. ResultsSixty-one charts were reviewed. The mean age was 28 months; 55.7% of the patients were male. Most cases were in the autumn and winter; 79% occurred from 2002 to 2008. Most cases (82%) had antecedents of an upper airway catarrhal process and 60.7% had a clinical diagnosis of acute otitis media. Prior antibacterial agent therapy had been administered in 55.7% of the cases. Culture of middle ear effusions was performed in 48 patients, revealing Streptococcus pneumonia in 39.7%, Haemophilus influenzae in 2%, Staphylococcus aureus in 12.5% and Pseudomonas aeruginosa in 8.3%. Cultures were sterile in 18 patients (37.5%). Of the pneumococcal isolates, 26.2% were resistant to penicillin or third generation cephalosporins. Most cases (93.4%) responded well to antibacterial therapy alone or with myringotomy. There were complications in 7 patients (11.5%). Mastoid surgery was performed in 4 patients. ConclusionsAcute mastoiditis shows a rising incidence in recent years. The most commonly isolated form is the pneumococcus, the high rates of antibiotic resistance in our study being notable. Treatments with antibiotics alone or in combination with myringotomy are effective in less severe forms.

Iatrogenic facial nerve palsy "Prevention is better than cure": Analysis of four cases

Iatrogenic facial nerve palsy in mastoid surgery is considered a crime or a taboo in the present scenario of medical science. But one has to accept the fact that every otologist encounters this entity at some point in his/her career. Hence it is of prime importance to be equipped to detect and to manage these cases. The obvious and disfiguring facial deformity it causes makes this a dreaded complication. Our article here discusses our experience in managing four cases of iatrogenic facial palsy. The etiology in all the cases was mastoidectomy for cholesteatoma. The detection of the site and repair was performed by the same surgeon in all cases. The facial nerve was transected completely in three cases, and in one case there was partial loss (>50%) of fibers. Cable nerve grafting was utilized in three patients. There was grade 4 improvement in three patients who underwent cable nerve grafting, and one patient had grade 2 recovery after end-to-end anastomosis. A good anatomical knowledge and experience with temporal bone dissection is of great importance in preventing facial nerve injury. If facial nerve injury is detected, it should be managed as early as possible. An end-to-end anastomosis provides better results in final recovery as opposed to cable nerve grafting for facial nerve repair.

Mastoiditis aguda en la época de la vacuna antineumocócica

Introduction and objectives Acute mastoiditis is the most common complication of acute otitis media. Recent studies have noticed an increase in cases. The goal of this study was to review acute mastoiditis cases diagnosed in children younger than 14 years old. Material and methods A retrospective study of all patients under 14 years old admitted with a diagnosis of mastoiditis between 1996 and 2008 was performed. Epidemiological, laboratory and clinical variables were analysed. Results Sixty-one charts were reviewed. The mean age was 28 months; 55.7% of the patients were male. Most cases were in the autumn and winter; 79% occurred from 2002 to 2008. Most cases (82%) had antecedents of an upper airway catarrhal process and 60.7% had a clinical diagnosis of acute otitis media. Prior antibacterial agent therapy had been administered in 55.7% of the cases. Culture of middle ear effusions was performed in 48 patients, revealing Streptococcus pneumonia in 39.7%, Haemophilus influenzae in 2%, Staphylococcus aureus in 12.5% and Pseudomonas aeruginosa in 8.3%. Cultures were sterile in 18 patients (37.5%). Of the pneumococcal isolates, 26.2% were resistant to penicillin or third generation cephalosporins. Most cases (93.4%) responded well to antibacterial therapy alone or with myringotomy. There were complications in 7 patients (11.5%). Mastoid surgery was performed in 4 patients. Conclusions Acute mastoiditis shows a rising incidence in recent years. The most commonly isolated form is the pneumococcus, the high rates of antibiotic resistance in our study being notable. Treatments with antibiotics alone or in combination with myringotomy are effective in less severe forms.

Subjective and objective outcomes of tympanoplasty surgery at National Hospital Abuja, Nigeria 2005–2009

The objective of this study is to determine the subjective and objective outcomes of tympanoplasty surgery carried out in patients with otitis media and to identify factors responsible for these outcomes. The study setting is tertiary care urban referral hospital in a developing economy and the study methodology is a prospective analysis of patients with diagnosis of chronic suppurative otitis media that had tympanoplasty with or without mastoidectomy between May 2005 and September 2009 at National Hospital Abuja. Subjects were evaluated for age, sex, size and site of perforation, status of operated ear(s) (dry/discharging), status of the contralateral ear, surgical technique, subjective and objective pre-operative and post-operative hearing scores, average post-operative follow-up time, and post-operative complications, and results were statistically analyzed. A total of 45 patients (51 ears) were operated. Age distribution was 8-52 years. Type 1 tympanoplasty was done in 41 patients and Type 3 in 4 patients. Seven of the patient had concomitant mastoid surgery (cortical mastoidectomy). 3/51 of the cases had discharging ears at surgery. 16/45 of the patients (19/51 ears) had cartilage graft tympanoplasty, while 29/45 (32 ears) had temporalis fascia tympanoplasty. 15/16 of the cartilage group as well as 26/29 of the fascia group reported subjective hearing improvement, whilst the actual graft take was 12/16 of the cartilage group and 23/29 of the fascia group. Objective hearing improvement was observed in all of the cartilage as well as 26/29 of the fascia group. This study confirms success of tympanoplasty among Nigerians, and recommends that subjective hearing assessment should form part of indicators for success following tympanoplasty.

Retrospective and Prospective Study of Singapore Swing Method on Healing of Mastoid Cavity

Chronic suppurative otitis media with cholesteatoma is a common problem. The majority of ENT surgeons find the canal wall down operation to be the safest and simplest means of treating cholesteatoma. The 'Singapore Swing' is a method of promoting healing of mastoid cavity. In this study our main objective was to do Singapore Swing technique in larger number of cases, have long term follow-up and to compare its results with other mastoid operations in which obliteration has not been used. Patients of cholesteatoma were divided into case group and control group. The case group (26 patients) was operated by canal wall down procedure with Singapore Swing obliteration while the control group (62 patients) was operated by same method without any obliteration. Both retrospective and prospective studies were done. Time period of drying of mastoid cavity, numbers of visits to the hospital and hearing status were observed. Subjective satisfaction score of patient (0-10) and Surgeon's satisfaction score (fully satisfied, partially satisfied and not satisfied at all) were measured in both the groups. The time of drying of cavity was <2months in 88.5% of cases, while 27.5% of controls. Mean time of drying of cavity was 46days (1½months) in case group, while it was 89days (3months) in control group. Gain in air conduction was 11-30dB in 33.3% cases and 15.7% of controls. 2 patients in control group had deterioration of 1-10dB in air conduction. Subjective satisfaction score was 8-10 in 42.4% patients in case group, while 25% in control group. Surgeon was fully satisfied in 73% patients of case group and 45% patients of control group. The study suggested that Singapore Swing technique provides a dry, small and stable cavity with better hearing in less time.