Published: 2021-02-24

Retrospective analysis of difficulties during mastoid surgeries in tertiary referral center in Nepal

Yogesh Neupane, Bijaya Kharel, Kripa Dongol, Rabindra B. Pradhananga, Pabina Rayamajhi, Heempali Dutta


Background: Complications can occur during and following mastoidectomy because of the variation in the temporal bone anatomy and surgical factors. The operating surgeon needs to be aware of potential difficulties and their clinical relevance to avoid the dread complication. This study aims to study various per-operative difficulties and complications encountered during mastoid surgery.

Methods: A retrospective study was conducted, including 152 cases of chronic otitis media squamous type who underwent mastoidectomy from June 2017 to January 2019. Revision cases and cases with missing records on per-operative findings, early postoperative status, hearing assessment were excluded from the study.  

Results: Out of 152 cases, there were 80 males and 72 females with a mean of 27.5 years. Dural plate breach was recognized in 19 cases (12.5%) with iatrogenic injury in 16 cases. Breach of sinus plate and exposure of sigmoid sinus was noted in 11 cases (7.24%) and all were iatrogenic. Korner’s septum was noted in five cases (3.29%). The facial canal was dehiscence in 25 cases (16.4%) with the majority in the horizontal segment, but the sheath was intact in all cases. Immediate postoperative facial nerve palsy was seen in four cases (2.6%). Fistula in the lateral semi-circular canal was noted in two cases. Taste disturbance was noted in 13 cases. Local complications related to the surgical site was seen in 19 cases.

Conclusions: The anatomic variations and surgical difficulty are common in mastoid surgery. The major complication rate is around 2-3% despite various mastoid variation and difficulties.


Mastoidectomy, Anatomic variations, Complications

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Acuin J. Chronic suppurative otitis media. Clin Evid. 2006;15:772-87.

Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M, et al. EAONO/JOS joint consensus statements on the definitions, classification and staging of middle ear cholesteatoma. J Int Adv Otol. 2017;13(1):1-8.

Wang HM, Lin JC, Lee KW, Tai CF, Wang LF, Chang HM, et al. Analysis of mastoid findings at surgery to treat middle ear cholesteatoma. Arch Otolaryngol Head Neck Surg. 2006;132(12):1307-10.

Visvanathan V. Anatomical variations of the temporal bone on high-resolution computed tomography imaging: how common are they? J Laryngol Otol. 2015;129(7):634.

Wormald PJ, Nilssen EL. Do the complications of mastoid surgery differ from those of the disease? Clin Otolaryngol Allied Sci. 1997;22(4):355-7.

Tatlipinar A, Tuncel A, Öğredik EA, Gökçeer T, Uslu C. The role of computed tomography scanning in chronic otitis media. Eur. Arch. Oto-Rhino-L. 2012;269(1):33-8.

Monasta L, Ronfani L, Marchetti F, Montico M, Brumatti LV, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PloS one. 2012;7(4):36226.

Chrisanthus J, George S. Mastoidectomy: retrospective analysis of 137 cases in a tertiary care hospital. Int J Otorhinolaryngol Head Neck Surg. 2018;4(1):93.

Alves RD, Cabral Junior F, Fonseca AC, Bento RF. Mastoid obliteration with autologous bone in mastoidectomy canal wall down surgery: a literature overview. Int Arch Otorhinolaryngol. 2016;20(1):76-83.

Yorgancilar E, Akkus Z, Gun R, Yildirim M, Bakir S, Kinis V, et al. Temporal bone erosion in patients with chronic suppurative otitis media. B-ENT. 2013;9(1):17-22.

Wiatr M, Składzień J, Stręk P, Przeklasa-Muszyńska A, Wiatr A. Chronic Otitis Media with Granulation Is a Poor Prognostic Factor for Hearing Improvement and Development of Intracranial Complications. J Int Adv Otol. 2019;15(1):12-7.

Kanotra S, Gupta R, Gupta N, Sharma R, Gupta S, Kotwal S. Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma. Indian J Otol. 2015;21(4):280-5.

Wojciechowski T, Skadorwa T, Drożdż A, Ciszek B, Szopiński K. The radioanatomical assessment of the Körner’s septum. Surg Radiol Anat. 2019;41(6):669-73.

Li D, Cao Y. Facial canal dehiscence: a report of 1,465 stapes operations. Ann Otol Rhinol Laryngol. 1996;105(6):467-71.

Moreano EH, Paparella MM, Zelterman D, Goycoolea MV. Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: a report of 1000 temporal bones. Laryngoscope. 1994;104(3):309-20.

Albera R, Canale A, Piumetto E, Lacilla M, Dagna F. Ossicular chain lesions in cholesteatoma. Acta Otorhinolaryngol. 2012;32(5):309.

Mohammadi G, Naderpour M, Mousaviagdas M. Ossicular erosion in patients requiring surgery for cholesteatoma. Iran J Otorhinolaryngol. 2012;24(68):125.

Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol. 2010;62(4):421-6.

Cook JA, Krishnan S, Fagan PA. Hearing results following modified radical versus canal-up mastoidectomy. Ann Otol Rhinol Laryngol. 1996;105:379-83.

Berenholz LP, Rizer FM, Burkey JM, Schuring AG, Lippy WH. Ossiculoplasty in canal wall down mastoidectomy. Otolaryngol. Head Neck Surg. 2000;123(1):30-3.

Cheng-Chuan C, Mu-Kuan C. Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma. J Otolaryngol-Head N. 2000;29(5):270.

Gurung U, Bhattarai H, Shrivastav R. Taste disturbances following middle ear surgery. J Inst Med. 2010:32(3):18-23.

Saito T, Manabe Y, Shibamori Y, Yamagishi T, Igawa H, Tokuriki M, et al. Long‐term follow‐up results of electrogustometry and subjective taste disorder after middle ear surgery. Laryngoscope. 2001;111(11):2064-70.

Clark MP, O’Malley S. Chorda tympani nerve function after middle ear surgery. Otol Neurotol. 2007;28(3):335-40.