Surgical techniques to facilitate endoscopic second-look mastoidectomy

Mastoidoscopy has shown to be a safe, effective alternative to traditional second-look mastoidectomy. This study was undertaken to review surgical modifications to facilitate successful mastoidoscopy.

Retrospective database review of all surgical procedures performed by the senior author (T.J.H.) since January 1995. All surgeries were performed in a tertiary hospital setting.

Fifteen second-look procedures were performed in this series. Five were performed endoscopically, 10 with traditional techniques. In the traditional surgeries five were prior to the use of endoscopy, five had contraindications to endoscopic mastoidectomy. There were six residual cholesteatomas in the series, one in the endoscopic cases (20%), and five in the traditional cases (50%). No cholesteatomas were identified with microscopic examination performed after endoscopy. There were no complications in the series. Mastoidoscopy gives limited access to the mesotympanum, eustachian tube and, in particular, the sinus tympani. The creation of a wide extended facial recess with removal of the buttress at the fossa incudis and removal of the incus and head of the maleus will facilitate inspection of the middle ear. Additional techniques are necessary to view the sinus tympani. The fallopian bridge technique, and the infratympanic extended facial recess technique may allow better visualization of the middle ear.

Mastoidoscopy offers a safe alternative to traditional techniques for second-look surgery. The morbidity appears similar to traditional techniques.