Modified radical mastoidectomy in children: mastoid cavity problem and its management

Heempali Das Dutta, Pabina Rayamajhi, Deepak Dutta


Background: Various factors are responsible for post MRM chronically discharging mastoid cavity which has to be identified and treated properly so as to avoid further complications. The aim of this study is to evaluate the causative factors responsible for persistent ear discharge in post mastoidectomy cases and their management in paediatric age group.

Methods: This is a cross sectional study done from May 2013 to April 2017 in the Paediatric ENT unit of Department of ENT & HNS, TUTH, Kathmandu, Nepal. Children were evaluated for persistent ear discharge and managed for one year. Risk factors like high facial ridge, inadequate meatoplasty, unepithelize mastoid cavity, tympanic membrane perforation and residual or recurrent choleateatoma, infections, nasal or nasopharngeal pathology were evaluated and treated. Outcome of management was measured in terms of achieving dry mastoid cavity over one year period.  

Results: A total of 92 post MRM children with persistent discharge were included in the study. 33/92 (35.8%) had anatomical defects. Four cases had recurrent or residual cholesteatoma. 22/92 (23.9%) of the cases had granulation and infection. 14 cases had nasophayngeal inflammation and 13 cases had recurrent accumulation of wax or debris. After the treatment of various factors, 43/75 (53.7%) ear became dry within 3 months, 22/75 (29%) ear became dry within 6 months, 6/75 had persistent discharge even 1 year after treatment. Whereas, in 5/75 (13.4%) had on and off discharge.

Conclusions: The chronically discharging mastoid cavity can be well managed by early identification of causative factors.


MRM, Persistent ear discharge, Causative factors

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Olszewska E, Rutkowska J, Özgirgin N. Consensus-based recommendations on the definition and classification of cholesteatoma. J Int Adv Otol. 2015;11(1):81–7.

William PLH. Chronic Otitis Media. In: Jhon CW, Raymon WC, editors. Scott- Brown’s Otorhinolaryngology, Head and Neck Surgery. 8th edition; 2018:155-163.

Lindroos R. Surgery for chronic ear disease in a non-university hospital:open cavity, obliteration and intact canal wall techniques. Clin Otolaryngol Allied Sci. 1991;16(3):252-8.

Fowler S. Mastoidectomy audit:results of the Royal College of Surgeons of England comparative audit of ENT surgery. Clin Otolaryngol Allied Sci. 1995;20(1):89–94.

Merchant SN, Wang P, Jang CH. Efficacy of tympanomastoid surgery for control of infection in active chronic otitis media. Laryngoscope. 1997;107(7):872–7.

Stark TH, Dazert S, Sudhoff H. Fibrocartilaginous Eustaquian tube and cholesteatoma: Middle ear cleft. Kugler Publications; 2003: 125-132.

Nadol JB. Causes of failure of mastoidectomy for chronic otitis media. Laryngoscope. 1985;95(4):410-3.

Nadol JB Jr. Revision mastoidectomy. Otolaryngol Clin North Am. 2006;39(4):723-40.

Wormald PJ, Nilssen EL. The facial ridge and the discharging mastoid cavity. Laryngoscope. 1998;108(1):92–6.

Megerian CA, Cosenza MJ, Meyer SE.Revision tympanomastoid surgery. Ear Nose Throat J. 2002;81:718–26.

Austin DF. Single-stage surgery for cholesteatoma: an actuarial analysis. Am J Otol. 1989;10(6):419–25.

S. Prasanna Kumar, Ravikumar A, and Somu L Modified Radical Mastoidectomy:A Relook at the Surgical Pitfalls Indian J Otolaryngol Head Neck Surg. 201365(3):548–52.

Weiss MH, Perisier SC, Han JC, Edelstein DR. Surgery for recurrent and residual cholesteatoma. Laryngoscope. 1992;102(2):145-51.

Jackson CG, Glasscock ME, Schwaber MK. A surgical solution for the difficult chronic ear. Otol Neurotol. 1996;17(1):7–14.

Mills RP. Surgical management of discharging mastoid cavity. J Laryngol Otol. 1988:1-6.

An-ting X, Ming X, Han-bing Z, Kimitaga K. Bacteriolgy before and after total middle ear reconstruction. J Otol. 2007;2(2):114-8.

Ojala JK, Sorri M, Sipila A. Comparison of Preoperative and postoperative bacteriology of Chronic ears. J Laryngol Otol. 1992;95:1.

Nguyen DT, Orgill DP, Murphy GF. The pathophysiologic basis for wound healing and cutaneous regeneration. Biomaterials for Treating Skin Loss. Boca Raton/Cambridge: CRC Press (US) & Woodhead Publishing (UK); 2009: 25-57.