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Outpatient management of cholesteatoma with canal wall reconstruction tympanomastoidectomy

Richard Kao1, Todd Wannemuehler1, Charles W Yates1

  • 1Department of Otolaryngology-Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A.

Laryngoscope Investigative Otolaryngology
|January 5, 2018
PubMed
Abstract

Insights

Postoperative oral antibiotics after canal wall reconstruction tympanomastoidectomy show a low infection rate, matching historic intravenous antibiotic effectiveness for chronic otitis media with cholesteatoma treatment.

Area of Science:

  • Otolaryngology
  • Infectious Disease
  • Surgical Outcomes

Background:

  • Chronic otitis media with cholesteatoma requires surgical intervention, often canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration.
  • Postoperative wound infections following CWR are a concern, with a reported rate of 3.6%.
  • Intravenous antibiotics for 24-48 hours post-surgery have been the standard recommendation.

Purpose of the Study:

  • To evaluate the postoperative wound infection rate using outpatient oral antibiotics after CWR tympanomastoidectomy.
  • To compare the efficacy of outpatient oral antibiotics with historical data of inpatient intravenous antibiotics.

Main Methods:

  • Retrospective case review of 51 patients undergoing CWR tympanomastoidectomy with mastoid obliteration.
  • Patients received postoperative outpatient oral antibiotics.
  • Infection rates and complications within one month of surgery were analyzed.

Main Results:

  • No postoperative wound infections were observed in the study group (0%).
  • Outpatient oral antibiotics demonstrated non-inferiority to historical intravenous antibiotic use (0% vs. 3.6%).
  • One case of wound dehiscence with CSF leak and one case of C. difficile colitis occurred.

Conclusions:

  • Canal wall reconstruction tympanomastoidectomy with mastoid obliteration using postoperative outpatient oral antibiotics results in a low infection rate.
  • This approach is non-inferior to historical treatment with inpatient intravenous antibiotics.
  • Further investigation via a randomized controlled trial is recommended.
Keywords:
Canal wall reconstructionantibioticscholesteatomaoutpatienttympanomastoidectomy

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