Modified Radical Mastoidectomy Research Articles

Intravenous tranexamic acid significantly improved visualization and shortened the operation time in microscopic middle ear surgery: a randomized controlled trial.

The microscopic middle ear surgery involves a limited operating space and numerous important anatomical structures in which good visualization is crucial, as even a small amount of bleeding can greatly affect the clarity of surgical field. This study aims to investigate whether intravenous 1gram of tranexamic acid can improve surgical visualization and further shorten the operation time in microscopic middle ear surgery. This study is a prospective, randomized, double-blind, controlled trial conducted from December 2021 to December 2022, enrolling patients who were scheduled for microscopic modified radical mastoidectomy due to chronic otitis media. In addition to standard techniques to optimize the surgical field, participants were randomized into the TXA (tranexamic acid) group (1gram diluted to 20mL normal saline) and the control group (20mL normal saline). The primary outcome was assessed based on the clarity of the surgical field using the Modena Bleeding Score. Secondary outcomes included operation time, the surgeon satisfaction with the visual clarity, postoperative 24-hour coagulation parameters, and the incidence of adverse events. Student's t test, Chi-square test and ANOVA of repeated measures were used for statistical analyses. A total of 28 patients were enrolled in each group using a 1:1 randomized allocation with similar demographic characteristics, including 24 male and 32 female individuals, and the mean age is 45.6±11.9 years. The surgical visualization in the TXA group was significantly better than that of the control group (2.29±0.46 vs. 2.89±0.31, P<0.001) as assessed by the Modena Bleeding Score. Furthermore, the TXA group demonstrated a shorter operation time compared to the control group (88.61±10.9 vs. 105.2±15.9, P<0.001) and higher surgeon satisfaction with surgical field (7.82±0.55 vs. 6.50±0.64, P<0.001). No statistically significant differences were found in postoperative coagulation parameters in the two groups. No TXA-related adverse events or complications occurred during the 12-month follow-up. Intravenous 1gram of TXA can further significantly improve the visual clarity in the microscopic middle ear surgery and shorten the operation time based on other standard measures implemented.

Incidence and Causes of Discharging Ear after Mastoid Exploration

Background: Chronic ear diseases, common in developing countries, often require mastoid exploration, leading to post-operative ear discharge. This study, conducted at ENT Unit I of Jinnah Hospital (November 2022 to November 2023), investigates postoperative ear discharge incidences across different mastoid exploration techniques. Objective: This cross-sectional study conducted at ENT Unit I of Jinnah Hospital, Lahore, from November 2022 to November 2023 aimed to investigate the incidence of post-operative ear discharge following different mastoid exploration techniques. The study sought to establish associations between surgical techniques and post-operative outcomes, including the nature of discharge and causative organisms.– Methods: A sample of 18 ears, systematically divided into three groups based on the surgical technique. The groups included Cortical Mastoidectomy (Group A), Radical Mastoidectomy (Group B), and Modified Radical Mastoidectomy (Group C). Purposive sampling was employed, and data were collected from patient records, including demographic information, surgicaltechniques, and culture results of ear discharge samples. Statistical analysis, including chi-square tests and Fisher's exact tests, was conducted to determine associations, with a significance level set at 0.05 Results: Incidence rates for Groups A, B, and C were 66.67%, 100%, and 54.55%, resulting in an overall incidence of 55.17% Microbiological analysis revealed prevalent causative organisms, including Pseudomonas aeruginosa and Staphylococcus aureus. Statistical analysis confirmed a significant association between surgical technique and outcomes. Conclusion: The study underscores the significance of tailoring mastoid exploration techniques to minimize post-operative ear discharge. Understanding the microbiological profile enhances targeted interventions for better patient outcomes.

Modified radical mastoidectomy in chronic otitis media: year outcome post-surgery

Background: Cholesteatoma is defined as erosive process, eroding ossicular chain, scutum, otic-capsule, fallopian canal and tegmun. Surgical management of cholesteatoma includes mastoidectomy. The aim of the study was to focuss on MRM: indications and outcomes of procedure. Methods: This study aims at knowing the indications and outcome of MRM after 1 year in terms of success rate, efficacy and patient’s satisfaction. It involves study over 42 patients who underwent surgery and were followed over a period of one year post surgery. Results: After 1 year of MRM 64.27% showed hearing improvement, 95.2% had dry and settled cavity, and there was no post-operative facial palsy, and SNHL. Conclusions: MRM is a procedure of choice for COM with extensive disease of mastoid. A meticulous and skilled MRM gives a well fashioned mastoid cavity with minimum or no recurrence/post-operative complications with a satisfactory hearing outcome.

A Study on Morphometric Changes of the Pinna Following Ear Surgery.

Morphometry of pinna may change following ear surgeries. This study gives information about postoperative changes following ear surgeries. This study aims to measure the variation of ear morphology following surgery and to correlate the type of surgery with post-operative variations. Eighty patients with Chronic Otitis Media(COM) undergoing surgery by post aural approach were grouped into Modified Radical Mastoidectomy (MRM), Cortical Mastoidectomy + Tympanoplasty (CM + TM) and Tympanoplasty groups(TM). The MRM, CM + TM and TM groups had 14, 46 and 20 participants respectively. Various morphometric measurements were taken pre and post operatively. In all groups, the mean Concho-Mastoid Angle (CMA) was increased post operatively, with increase of 11.1 degrees in MRM (p value-0.002), 8.9 degrees in CM + TM (p value-0.000) and 4.8 degrees (p value- 0.657) in TM group. Similarly, the Cepahlo-auricular distances (D1 and D2) showed statistically significant changes in MRM and CM + TM groups (p value < 0.05). Mean CMA of MRM group compared with other groups did not show any statistically significant difference. However, when the CMA of CM + TM group was compared with TM group showed significant difference of 14.53 degree (p value 0.002). Similarly, the D1 and D2 showed statistically significant changes between the CM + TM and TM groups (p value 0.005 and 0.000 respectively). Prominence of pinna following ear surgery is a not a myth. It happens mostly in cases requiring drilling of the mastoid, rather than Tympanoplasty alone. This needs to be explained to the patient beforehand to prevent any confusion post operatively.

Comparative study of quality of life and surgical outcome in open mastoid cavity and mastoid cavity obliteration in canal wall down mastoidectomy

Background: Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. The materials used for this reason are either biological or synthetic. Mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. Methods: This is a prospective study carried out in the department of otorhinolaryngology. Sample size: 30 patients out of which 15 were operated by Modified Radical Mastoidectomy with obliteration (Group A) and 15 were operated by Modified Radical Mastoidectomy without obliteration (Group B). Study design: single centre, longitudinal, prospective, two group, parallel, follow-up, randomly allocated statistical method and tools: Fischer’s Exact Test. Study period: August 2017 to August 2020. Results: Study was divided in two groups, group A (modified radical mastoidectomy with obliteration) &amp; group B (modified radical mastoidectomy without obliteration). Conclusions: The incidence of pain, discharge, giddiness and wax formation was markedly reduced in obliterated cavities as compared to open cavities. Healing of the cavity as evidenced by epithelialization, at the end of 3 months, was better in obliterated ears. Patients with obliterated mastoid cavity required less cavity care, doctor dependence, frequent OPD visits.

Overall outcome of Modified Radical Mastoidectomy (MRM)

Aims: To compare overall findings of our Modified Radical Mastoidectomy (MRM) practice with the available contemporary standards of international recognition. Design and Methodology: The cohort included the patients who underwent Modified Radical Mastoidectomy from 2013 to 2018 by the author, who were subjected to a retrospective study. The details obtained from clinic reports were preoperative and postoperative hearing (documented to the end of the fourth post op year), and findings that were documented intraoperatively and post operatively in successive clinic visits. The parameters analysed were hearing improvement, disease extension, anatomical variations, immediate and late post-operative complications. Result: There were no evidence of recurrence following the surgical intervention. Postoperative mean air-bone gap had reduced by 9.5dBHL, 5dBHL, 7.44dBHL, 4.9dBHL, 4.1dBHL, 3.75dBHL and 8.18dBHL at 0.125kHz, 0.250kHz, 0.5kHz, 1kHz, 2kHz, 4kHz and 8kHz respectively. Disease involvement was found in Attic, Antrum, Sinus tympani, facial recess, mesotympanum, oval window and posterior sinus, supra tubal recess, sinodural angle cells, sinus sub tympanum, external ear canal, in the descending order of occurrence. 36 audited patients achieved dry ears by the end of second year though some had at least one intermittent wet episode and 4 had continuous persistent wet ears. Intraoperative findings analysis showed 2.5% were observed with perilymph leak, 27.5% had erosion of malleus head by disease, 55% had erosion of incus, 90% intact suprastructure, 97.5% had intact stapes foot plate, 15% had significant dural overhang, 10% had exposed facial nerve, 10% had anterior sigmoid sinus and 2.5% had exposed dura. Immediate post intraoperative complications of 7.5% HB grade 1 facial nerve palsy, 42.5% taste alteration, 5% CSF leak, 25% complaining of disturbing head ache, 7.5% having exposed dura (iatrogenic), 7.5% had dressing removed due to risk of pressure necrosis of pinna or developing Facial nerve palsy and 2.5% (one) patient had the meatus migrating downward due to a connective tissue problem of skin. During post-operative period stitch abscess was noted among 5%, achieved self-cleaning dry ear in 15%, wax build up in the dry ear in 10%. However, over 50% patients had minimum of 1 episode of wet ear in this period. Meatal stenosis and keloid development was noted among 10% and, graft perforation among 20% and 2.5% (one) wound dehiscence. During post-operative period 7.5% developed BBPV and similar percentage had caloric effect during packing of the cavity while 22.5% developed caloric effect during suction of the cavity. Conclusions: The improvements in hearing when adjunct with Tympanoplasty in this audit keep up with recent compared studies. Further its ability to safely achieve a disease free ear is endorsed and complemented by the low complication rates.

Outcomes of canal wall down mastoidectomy in cholesteatoma: a 5-year experience

BackgroundCholesteatoma is an atticoantral disease that potentially causes life-threatening complications. Therefore, canal wall down mastoidectomy is a well-established technique to eradicate the disease, especially in extensive cholesteatoma.AimTo evaluate the status of dry ear and hearing outcome post-retrograde canal wall down mastoidectomy.MethodsA retrospective study of patients with cholesteatoma who underwent modified radical mastoidectomy (MRM), a form of canal wall down mastoidectomy between January 2014 and December 2018.ResultsFifty-seven patients were included with a mean age of 40 years. The majority of cases were adults, 86%, and 14% were children. Most of them complained of ear discharge (73.7%), followed by hearing loss (31.6%). Intraoperatively, cholesteatoma was primarily found in cases involving mastoid air cells, antrum, attic, and mesotympanum (47.4%). The presence of granulation tissue with cholesteatoma was noted in 57.9% of cases. Furthermore, 73.7 % of ossicular chain erosion cases involved erosion of all ossicles (47.6 %). In 26.3 % of cases, tegmen erosion was identified. Facial canal dehiscence accounted for 15.8% of MRM cases, sclerotic mastoid was noted for 10.5%, and lateral semicircular canal dehiscence involved 5.3%. Up to 3 months of follow-up post-MRM showed 70.2% had a dry ear. After 6 months, there were 15.8% complaints of ear discharge in the subsequent follow-up. In this study, 33 out of 57 patients underwent a postoperative hearing evaluation, and 21.2 % of patients showed an improvement in the air-bone gap.ConclusionCanal wall down mastoidectomy is a treatment of choice in extensive cholesteatoma to achieve a dry and safe ear with maintaining functional hearing outcomes.

An Unusual Case of Parry–Romberg Syndrome with Chronic Otitis Media: An Incidental Diagnosis or Underlying Cause?

Here, we present a case of a 17-year-old female, who presented to us with bilateral squamous active chronic otitis media and underwent surgery for the same, along with progressive atrophy of the right side of the face for the past 2 years. A 17-year-old female patient presented to us with progressive hemiatrophy of the right side of the face for 2 years and foul-smelling discharge from both ears, also for 2 years. She subsequently underwent a modified radical mastoidectomy of the left ear. Parry–Romberg syndrome is a rare acquired disorder, causing progressive hemiatrophy of the skin and soft tissues of the face, along with, in some cases, atrophy of the muscles, cartilage, and underlying bone. There is no proven underlying etiology, and treatment consists of a delay of disease progression, a wait-and-watch policy, and esthetic restoration of the face once the disease progression halts.

Modified Radical Mastoidectomy: Open Mastoid Cavity versus Cavity Obliteration Using Periosteal Temporofascial Flap - A Comparative Study

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

A rare occurrence of Serratia rubidaea in a patient with ear discharge

Serratia species are not as frequent as with more virulent members of the Enterobacteriaceae. However, when infections do arise, they are largely associated with Serratia marcescens. Presently, about 10 species of Serratia are recognized and infections caused by the remaining Serratia species are seldom recorded in literature, as they are not often isolated from clinical specimens. This is a case report of Serratia rubidaea isolated from ear discharge of a 35-year old female patient with no co-morbidities and with known history of chronic otomastoiditis for which the patient had undergone left modified radical mastoidectomy. Isolation of this bacterium from clinical specimens is rare; however, it can be an etiological agent for infections in patients who have undergone invasive procedures. The patient was managed with antibiotics and on otoendoscopy at follow-up, no discharge was observed.

A RETROSPECTIVE STUDY OF FUNCTIONAL OUTCOMES IN PATIENTS OPERATED FOR MODIFIED RADICAL MASTOIDECTOMY AT TERTIARY CARE CENTRE, AHMEDABAD.

Background: Chronic otitis media is inammatory process in middle ear space that results in long term, or more often permanent change in tympanic membrane incuding atelectasis, dimer formation, perforation, tympanosclerosis, retraction pocket development or cholesteatoma. Classication of chronic otitis media(COM)into 1)COM with/without cholesteatoma (squamosal/mucosal) 2) Chronic inactive otitis media 3) Chronic inactive otitis media with frequent reactivation Aims: Study Design: Setting:To assess hearing improvement in patients undergoing Modied radical mastoidectomy. A Retrospective study. ENT Department Materials and Methods:GMERS MEDICAL COLLEGE AND HOSPITAL SOLA, AHMEDABAD It was a retrospective study carried out in a tertiary care centre ENT DEPARTMENT SOLA ,AHMEDABAD for a period of one year from JANUARY 2022 To JUNE 2022. 50 cases OPERATED FOR MODIFIED RADICAL MASTOIDECTOMY were included in this study. The parameters included in the study were age, gender, TYPE OF THE DISEASE,type of opearation and pre operatively audiogram and post operatively audiogram..Data were analysed - Out of 50 patients undergoing modied radical mastoidectomy, 46 patietns have improved hearing and getting dry ,selfResult cleansing ear Modied radical mastoidectomyn is ideal procedure for cholesteatoma or chronic otitis media atticoantral type.itConclusions: gives advantage of hearing improvement ,gives dry ,self cleansing healthy cavity in ear.

Comparative Study of Hearing Status After Modified Radical Mastoidectomy with And Without Reconstruction

Chronic suppurative otitis media (CSOM) is a communal ailment of the middle ear Objective: To compare hearing status with and without reconstruction after a modified radical mastoidectomy. Methods: 40 total patients with Chronic suppurative otitis media (the Atico-antral variety) who endured a modified radical mastoidectomy (MRM) with reconstruction or without reconstruction were enrolled in the study. The subjects were alienated into 2 groups depending on the surgical procedure. Patients done with modified radical mastoidectomy but reconstruction was not accomplished were added in the group I (n = 20), and patients done with reconstruction after MRM (n = 20) added to the group II. The patients were thoroughly examined one week before the operation, and their hearing levels were assessed using pure tone audiometry. The general anesthesia was given to the patients of both groups and operated under a microscope with post auricular approach. Temporal fascia and cartilage were collected as a material for grafting after modified radical mastoidectomy in group II. After surgery, patients were monitored at regular intervals. After 8 weeks, pure tone audiometry was performed and the closure of the air-bone gap was compared with the hearing assessment. Results: Many of the patients in this analysis were amongst 11 and 20 years of age and the majority of patients were male. Bone-air gap closure was more common in patients undergoing reconstructive MRM. Conclusion: Reconstruction after MRM results in improved hearing amplification and similarly results in greater improvement of life quality.

A clinical study of outcome of two different methods of meatoplasty following modified radical mastoidectomy

Background: Meatoplasty usually is the final step of a canal wall down mastoidectomy. It provides sufficient enlargement of the external auditory meatus which leaves the patient with a smaller mastoid recess that could readily be cleaned and examined without anatomical restriction. Aims and Objectives: The aims of this study were to study the outcome of two different methods of meatoplasty following modified radical mastoidectomy. Materials and Methods: This is a prospective study done for 2 years from January 2020 to December 2021 on 50 patients of chronic otitis media unsafe type, where modified radical mastoidectomy was done followed by meatoplasty. Results: The result in both the groups is comparable up until the meatus remains wide and large which could facilitate cavity examination, aeration, debridement, and drainage. Conclusion: Outcome was favorable in both the groups and complications related to the meatoplasty technique was also comparable.

An Effective Method to Collect Bone Dust for Mastoid Cavity Obliteration.

To compare the volume of cortical bone dust collected and the time taken for bone dust collection by using a self-devised bone dust collector and that by manual method using a metal scoop in patients undergoing modified radical mastoidectomy with mastoid cavity obliteration. A prospective study was done in 62 patients of cholesteatoma. They underwent canal wall down mastoidectomy. Mastoid cavity was obliteration was done using cortical bone dust collected after dividing the patients randomly into 2 groups: (1) usinga collector device made using a mucous extractor fitted with a nylon mesh of size 1″ × 3″attached to the suction tube, (2) collected manually by using a metal scoop. The time taken for the collection of bone dust was recorded and the volume of bone dust collected was measured and recorded. We found that the time taken for the collection of bone dust was significantly lower and the volume of bone dust collected was higher using a mucous extractor as compared to that by manual collection using a metal scoop. The suction based mucous extractor performed better in terms of both time taken for collection and also in the volume of cortical bone dust that was collected as compared to manual collection using a metal scoop. Therefore, we conclude from our study that using the suction based mucous extractor is a more effective method of cortical bone dust collection for mastoid cavity obliteration.

Discussion and expostulations on postoperative worsening of hearing following middle ear surgeries

BackgroundHearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss. As the initial indication for operation is to treat precisely this problem, this complication poses a major dilemma for surgeons. We, thus, aimed to detect the proportion of postoperative worsening of hearing, causes, and risk factors in patients undergoing middle ear surgery.MethodThis retrospective descriptive study was conducted in the department of otolaryngology of a tertiary care center and data of medical records were retrieved from January 2016 until December 2020. This study included middle ear surgery patients with pre- and postoperative audiometric results. Those patients whose hearing worsened post-operatively (where bone conduction deteriorated > 10 dB) were noted and assessed accordingly.ResultsThe medical records regarding morphological and audiological outcomes of 178 patients were available. We observed auditory degradation after surgery in eight patients (five primary cases and three revision cases), with an overall incidence rate of 4.49%. The mastoidectomy was performed in seven cases, either cortical (n = 5) and modified radical (n = 2). Modified radical mastoidectomy showed the greatest incidence of hearing loss (40%) among all surgical procedures. Except in one case, where sudden, profound loss occurred following otorrhoea on third day, hearing loss was progressive in rest of cases.ConclusionA patient with deteriorating hearing after middle ear surgery must be evaluated properly. There is an increased chance of hearing loss following surgery that involves more ossicular manipulation, drilling, extensive disease clearance, and revision. Utmost care must be taken while operating around ossicles and during disease clearance in key areas. Proper consent should be taken from such patients to avoid future litigations.

A retrospective analysis of facial palsy in patients of squamosal chronic suppurative otitis media with diabetes mellitus

Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House–Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.

Rare Case Report: Serratia Liquefaciens and Enterococcus Species as a Cause of Otogenic Brain Abscess Secondary to Active Epithelial Chronic Suppurative Otitis Media (CSOM) in a 12-Year Old Male Patient with Hemiparesis

Developing countries face the problem of Otogenic intracranial complications especially in paediatric population because of poor hygiene, malnutrition and low immunity. Active epithelial type Chronic Suppurative Otitis Media (CSOM) can be the cause of potentially fatal complications. One of these is otogenic brain abscess. Having an estimated annual incidence to be approximately 0.5 per 100,000 children, it is associated with high mortality. We describe a unique case of otogenic brain abscess secondary to Active epithelial CSOM being neglected for two years and finding an unexpected foreign body in the right ear canal in a 12-year-old boy. The consultation was sought when the headache became intense and hemiparesis appeared. Our case is unique regarding both the clinical presentation and the causative organism. The patient underwent craniotomy, with elective capsulotomy, drainage of abscess and placement of a ventriculoperitoneal shunt. This was followed by a modified radical mastoidectomy two weeks later and an uneventful recovery.

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........

Trainee-trainer outcomes in mastoid surgery: a comparative study.

Mastoid exploration remains an advanced, mainstay operation within ENT, in which the surgical trainees' role has been debated. This audit compares mastoid exploration outcomes between trainees and consultants. Cortical mastoidectomy, atticotomy, atticoantrostomy, modified radical mastoidectomy, combined-approach tympanoplasty and revision mastoidectomy operations performed between 2009 and 2020 were reviewed. Complications assessed were: facial palsy, labyrinth injury, dead ear, disease recurrence and time to recurrence. The chi-square test was used to determine significant associations. A total of 118 operations were surveyed. Thirty-five per cent of procedures (n = 41) were performed by trainees under supervision, and 65 per cent (n = 77) were carried out solely by consultants. Patients from 5 per cent of trainees' operations (n = 2) developed recurrence, compared with 7.8 per cent of consultants' (n = 6) (p = 0.55). No other complications developed in either group. The results corroborate those of other studies, indicating no significant increase in complication rate from consultants to trainees. Trainees likely completed less complicated cases. The stepwise incorporation of trainees did not compromise patient safety.

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;