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Mastoid surgery at the Red Cross War Memorial Children's Hospital 1986-1988
1Department of Otolaryngology, University of Cape Town Medical School.
Insights
Mastoid surgery in children aged 0-12 years treated acute mastoiditis, chronic suppurative otitis media (CSOM), and cholesteatoma. Open cavity surgery with temporalis fascia lining improved healing outcomes.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes
- Pediatric Infectious Diseases
Background:
- Mastoid surgery is a critical intervention for various pediatric ear conditions.
- Understanding the indications and outcomes in children is essential for effective management.
- Previous studies have highlighted the complexities of mastoid surgery in pediatric populations.
Purpose of the Study:
- To analyze the indications, complications, and surgical outcomes of mastoid surgery in children.
- To evaluate the effectiveness of different surgical approaches for specific conditions.
- To identify factors influencing healing and graft success in pediatric mastoidectomy.
Main Methods:
- Retrospective review of 83 children (0-12 years) undergoing mastoid surgery between 1986-1988.
- Categorization of indications: acute mastoiditis, uncontrolled chronic suppurative otitis media (CSOM), cholesteatoma, and miscellaneous.
- Analysis of surgical techniques, including tympano-mastoid surgery and open cavity procedures with temporalis fascia grafting.
Main Results:
- Indications included acute mastoiditis (30), uncontrolled CSOM (24), and cholesteatoma (22).
- Complications were observed in 23% of cases.
- Tympano-mastoid surgery for CSOM showed 79% graft success; open cavity surgery with temporalis fascia lining improved healing for cholesteatoma.
Conclusions:
- Mastoid surgery in children addresses diverse pathologies with varying age distributions.
- Surgical approach and graft material significantly impact outcomes, particularly in cholesteatoma cases.
- Open cavity surgery, especially when lined with temporalis fascia, demonstrates improved healing in pediatric mastoidectomy.
Abstract:
Eighty-three children between ages 0-12 years had mastoid surgery in the three year period 1986-88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4-12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2-12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3-12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.