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Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Impact of mastoidectomy on simple tympanic membrane perforation repair
Benjamin M McGrew1, C Gary Jackson, Michael E Glasscock
1Departments of Surgery and Otolaryngology-Neurotology/Skull Base Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Objectives/Hypothesis:
Mastoidectomy has long been identified as an effective method of treatment for chronic ear infection. The effect of mastoidectomy on patients without evidence of active infectious disease remains highly debated and unproven. The objective in the study was to examine the impact of mastoidectomy on the repair of uncomplicated tympanic membrane perforations.
Study Design:
Retrospective study of patients at tertiary referral center.
Methods:
Four hundred eighty-four patients who underwent surgical repair of simple tympanic membrane perforations were identified and reviewed in a retrospective manner. Simple tympanic membrane perforations were defined as tympanic membrane perforations of any size and location without any of the following confounding variables: 1). active infection (active otorrhea, abnormal middle ear mucosa, or granulations tissue); 2). ossicular abnormalities (ossicular fixation, ossicular discontinuity, ossicular malformation, or ossicular absence); 3). cholesteatoma; or 4). prior attempt at tympanic membrane repair (prior tympanoplasty or mastoidectomy). Surgical outcome and clinical course were assessed to compare results of tympanic membrane perforation repair with and without canal wall up mastoidectomy.
Results:
Tympanic membrane repair was equally effective in both groups at 91%. Hearing results were comparable. Development of persistent ipsilateral otological disease requiring a subsequent ipsilateral procedure was approximately twice as common in the tympanoplasty group. In the tympanoplasty group, 14.1% of patients underwent subsequent ipsilateral otological procedures, and 6.1% of patients in the tympanoplasty with mastoidectomy intact canal wall group underwent subsequent ipsilateral procedures (P <.05). The most common subsequent ipsilateral procedures were tympanoplasty, tympanostomy tube placement, tympanoplasty with mastoidectomy canal wall up, and tympanoplasty with mastoidectomy canal wall down, in that order. After including untreated tympanic membrane perforations as subsequent procedures, the adjusted rate of subsequent procedures was 15.5% in the tympanoplasty group and 12.2% in the tympanoplasty with mastoidectomy group (P >.05).
Conclusion:
Mastoidectomy was not necessary for successful repair of simple tympanic membrane perforations. However, mastoidectomy impacted the clinical course in patients by reducing the number of patients requiring future procedures and by decreasing disease progression. This suggests that even in the absence of active evidence of infection, mastoidectomy improved the underlying disease process. Combining mastoidectomy with tympanoplasty during repair of simple perforations in patients with no active evidence of infection remains an appropriate option and may be valuable in reducing the need for future surgery.
Insights
Mastoidectomy is not essential for successful tympanic membrane repair but may reduce future ear surgeries. This study suggests mastoidectomy can improve the underlying disease process, even without active infection, making it a valuable option.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Ear Disease Management
Background:
- Chronic ear infections are often treated with mastoidectomy.
- The role of mastoidectomy in uncomplicated tympanic membrane perforations without active infection is debated.
- This study investigates the impact of mastoidectomy on the repair of simple tympanic membrane perforations.
Purpose of the Study:
- To evaluate the effectiveness of mastoidectomy in the surgical repair of uncomplicated tympanic membrane perforations.
- To compare the outcomes of tympanoplasty with and without canal wall up mastoidectomy.
- To determine if mastoidectomy influences the need for future otological procedures.
Main Methods:
- Retrospective study of 484 patients undergoing surgical repair of simple tympanic membrane perforations.
- Patients were divided into two groups: tympanoplasty alone and tympanoplasty with canal wall up mastoidectomy.
- Outcomes assessed included tympanic membrane repair success, hearing results, and subsequent ipsilateral otological procedures.
Main Results:
- Tympanic membrane repair success rates were similar (91%) in both groups.
- Hearing outcomes were comparable between the tympanoplasty and tympanoplasty with mastoidectomy groups.
- Patients undergoing tympanoplasty alone had approximately twice the rate of subsequent ipsilateral otological procedures compared to those who had mastoidectomy (14.1% vs. 6.1%).
Conclusions:
- Mastoidectomy is not required for successful tympanic membrane repair in simple perforations.
- However, mastoidectomy may reduce the incidence of future otological procedures and disease progression.
- Combining mastoidectomy with tympanoplasty for simple perforations, even without active infection, is a viable option to decrease the need for subsequent surgeries.
