Factors influencing decision making among ENT surgeons on performance of cortical mastoidectomy for CSOM-tubotympanic disease in quiescent/active stage: an opinion based study


  • H. Gayathri Department of ENT, A.C.S. Medical College, Chennai, India
  • Krishnamurthy Balachandran Department of ENT, A.C.S. Medical College, Chennai, India
  • Ponnan Rathnasamy Department of ENT, A.C.S. Medical College, Chennai, India
  • Christina Mary Paul Department of Community Medicine, A.C.S. Medical College, Chennai, India




CSOM, Cortical mastoidectomy, ENT, Tympanoplasty, Dry ear period


Background: As the role of cortical mastoidectomy as an adjunct to tympanoplasty in the management of CSOM tubotympanic type - quiescent stage remains controversial even today; we intend to study the factors that influence the decision of ENT surgeons on whether or not to perform cortical mastoidectomy in patients with CSOM (chronic suppurative otitis media) - active or quiescent ear.

Methods: During May to August 2016, 60 ENT surgeons within Chennai were asked to answer a pre-framed questionnaire on CSOM based on their personal surgical experience. The answers were collected by direct questionnaire method and the data subjected to appropriate statistical analysis.

Results: 65% surgeons expected a minimum dry ear period of ≤30 days before considering tympanoplasty alone (group 1) and the rest 35% members expected more than 30 days of dry ear period (group 2). Surgeons ≤40 years of age expected lesser duration of dry ear period prior to consideration of tympanoplasty alone (p =0.016). Group 2 surgeons performed cortical mastoidectomy in more number of cases (>50%) when compared to group 1 surgeons (p =0.03) for patients who presented first to them with a wet ear. There was a mixed opinion among surgeons within group 1 itself on whether or not they would do cortical mastoidectomy when they encountered patients who had congested remnant tympanic membrane, congested middle ear mucosa, myringosclerosis, ossicular chain discontinuity, sclerotic mastoids or treated septic foci in spite of the ear being dry for a month.

Conclusions: Though many surgeons consider that 30 days of dry ear period is sufficient to consider tympanoplasty alone, there is a division of opinion among themselves while facing specific clinical scenarios.


Smyth GD. Tympanic reconstruction. Fifteen year report on tympanoplasty. Part II. J Laryngol Otol. 1976;90(8):713–41.

Villardo RJM, Doyle WJ. Role of the mastoid in middle ear pressure regulation. The Laryngoscope. 2011;121:404-8.

Sade J. The correlation of middle ear aeration with mastoid pneumatization. The mastoid as a pressure buffer. Eurn Arch Otorhinolaryngol. 1992;249:301­4.

Holmquist J, Bergstorm B. The mastoid air cell system in ear surgery. Arch Otolaryngol. 1978;104:127-9.

Sheehy JL. Surgery of chronic otitis media. In: English G, editor. Otolaryngology, Revised edition. Volume 1. Philadelphia: Harper and Row; 1985: 1–86.

Jackler RK, Schindler RA. Role of the mastoid in tympanic membrane reconstruction. Laryngoscope. 1984;94(4):495–500.

McGrew BM, Jackson G, Glascock ME. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope. 2004;114:506–11.

Bhat KV, Naseeruddin K, Nagalotimath US, Kumar PR, Hegde JS. Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary? J Laryngol Otol. 2008;10:1–8.

Adunka OF, Buchman CA. Mastoidectomy: Otology, Neurootology and lateral skull base surgery. 1st edition. Volume 5. New York: Thieme; 2011: 295-296.

Panigrahi D, Das SR, Pani SK. Role of Cortical Mastoidectomy in Outcome of Myringoplasty in Active and Quiescent Stage of Tubotympanic Type of Chronic Suppurative Otitis Media. J Evol Med Dent Sci. 2015;4(69):11931-5.

Tawab HMA, Gharib FM, Algarf TM, ElSharkawy LS. Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non cholestea-tomatous Chronic Otitis Media: A Comparative Study. Clin Med Insights Ear Nose Throat. 2014;7:19–23.

Kamath MP, Suja S, Raghavendra R, Vinay R, Krishnam R. Success of myringoplasty: Our experience. Indian J Otolaryngol Head Neck Surg. 2013;65(4):358–62.

Albu S, Trabalzini F, Amadori M. Usefulness of cortical mastoidectomy in myringoplasty. Otol Neurotol. 2012;33(4):604–9.

Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in non choles-teatomatous chronic suppurative otitis media: is it necessary? Otolaryngol Head Neck Surg. 1997;117:592–5.

Kaur M, Singh B, Verma BS, Kaur G, Kataria G, Singh S, et al. Comparative Evaluation between Tympanoplasty Alone & Tympanoplasty Combined With Cortical Mastoidectomy in NonCholestea-tomatous Chronic Suppurative Otitis Media in Patients with Sclerotic Bone. IOSR J Dent Med Sci. 2014;14(6):40-5.

Mishiro Y, Sakagami M, Takahashi Y, Kitahara T. Tympanoplasty with and without mastoidectomy in non cholesteatomatous chronic otitis media. Eur Arch Otorhinolaryngol. 2001;258:13–5.

Eliades SJ, Limb CJ. The role of mastoidectomy in outcomes following tympanic membrane repair: A review. The Laryngoscope. 2013;123(7):1787–1802.

Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty. Clin Otol. 2005;30:115-20.

Kawatra R, Maheshwari P, Bhatt R. A Comparative Study of Role of Cortical Mastoidectomy in Myringoplasty. JEBMH. 2015;2(5)556-65.

El-kady AS, Haroun Y, Kassem KM, Galal O. The Value of Computed Tomography Scanning in Assessment of Aditus ad Antrum Patency and Choice of Treatment Line in Revision Myringoplasty. Med. J. Cairo Univ. 2009;77(2):53-7.

Manjunath MK, Jyothi Swarup R, Chary G, Shadab MD. Myringosclerosis: An Indication of A Blocked Aditus; Indian J Otolaryngol Head Neck Surg. 2012;64(3):230–2.

Selcuk A, Ensari S, Sargin AK, Can B, Dere H. Histopathological classification of tympanosclerotic plaques. Eur Arch Otorhinolaryngol. 2008;265:409-13.

Kakkar V, Sharma N, Garg S, Bishnoi S, Gulati A, Malik P. Role of cortical mastoidectomy on the results of tympanoplasty in tubotympanic type of chronic suppurative otitis media: National J Otolaryngol Head Neck Surg. 2014;2(11):1-3.

Dhingra PL. Cholesteatoma and Chronic Suppurative Otitis Media. In: Disease of Ear Nose and Throat. 4th edition. New Delhi: Elsevier; 2007: 67.

Rout MR, Mohanty D, Vijaylaxmi Y, Kamalesh B, Chakradhar M. Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation. Indian J Otol. 2012;18:7-10.

Torosa SZ, Habesoglua TE, Habesoglua M, Bolukbasib S, Naiboglua B, Karacaa CT, et al. Do patients with sclerotic mastoids require aeration to improve success of tympanoplasty? Acta Oto-Laryngologica. 2010;130(8):909-12.

Priya K, Karthikeyan P, Coumare VN, Sambandan AP. Evaluation of eustachian tube function in chronic suppurative otitis media (tubotympanic type) with reference to its treatment outcome. Indian J Otol. 2012;18:179-83.

Blue Stone CD. Assessment of Eustachian tube function. In: Jerger J, Editors. Handbook of clinical impedance Audiometry. New York: American Electormedics Corporation; 1975: 127-148.

Gopalakrishnan S, Kumar S. A study on chronic otitis media active mucosal type with sinusitis as focal sepsis. Otolaryngology. 2012;2(4):19-29.

Wehrs RE, Tulsa OK. Aeration of the middle ear and mastoid in tympanoplasty. Laryngoscope. 1981;91:1463–7.






Original Research Articles