DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20174662

Mastoidectomy: retrospective analysis of 137 cases in a tertiary care hospital

Jaya Chrisanthus, Shibu George

Abstract


Background: Mastoidectomy is a common otologic surgery and at times can be a lifesaving procedure. The aim of the study is to analyze surgical indications, operative parameters and per-operative findings encountered.

Methods: This is a retrospective study done in patients who had undergone mastoid surgeries between 1st Jan 2016 to 31st Dec 2016 in the Department of Otorhinolaryngology, Govt. Medical College hospital, Trivandrum.  

Results: Of the 137 patients the peak age incidence was 16 – 30 years. Cholesteatoma was present in 32% of which 91% had canal wall down mastoidectomy. 64% patients, mostly chronic otitis media- mucosal and inactive squamosal, underwent canal wall up procedure. In 62% cases the ossicular chain was eroded, which was mainly incus (87%). Abnormalities encountered within the mastoid during surgery were mainly dehiscent facial canal (17.5%), low lying dura (16.8%) and contracted antrum (15.3%). A positive association could be noted between contracted antrum and the position of sinus and dural plates, and was statistically significant. Co-existence of facial canal dehiscence with lateral canal fistula and dural plate dehiscence were also noted. The tympanoplasty procedures commonly employed in canal wall up procedures was Type I and 2, and in canal wall down procedure was Type 3.

Conclusions: Adequate skill development of the ear surgeons in the tertiary centre should be ensured, to individualize the procedure appropriate for each patient and optimize the outcome of surgery. Early referral to the nearby otological centre should be promoted not only to prevent complications but also for better post-surgical functional outcome.


Keywords


Chronic otitis media, Mastoidectomy, Anatomical abnormalities, Tympanoplasty

Full Text:

PDF

References


Lambert PR. Mastoidectomy. In: Flint PW, Haughey BH ed. Cummings Otolaryngol Head Neck Surg. 5th ed. PA: Moby Elsevier; 2010.

Chole R, Brodie H, Jacob A. Surgery of the Mastoid and Petrosa. In: Bailey, Byron J, ed. Head and Neck Surgery-Otolaryngology. 4th ed. Lippincott Williams &Wilkins; 2006.

Bluestone CD. Epidemiology and pathogenesis of chronic suppurative otitis media: implications for prevention and treatment. Int J Pediatr Otorhinolaryngol. 1998;42(3):207.

Acuin J. WHO Child and Adol. Health and Development, WHO Prevention of Blindness and Deafness. Chronic Suppurative Otitis Media Burden of Illness and Management Options. WHO Geneva; 2004.

Arunabha S, Tarique A, Debasish G, Bijan B. A study of surgical management of chronic suppurative otitis media with cholesteatoma and its outcome. Indian J Otolaryngol Head Neck Surg. 2010;62(2):171–6.

Lasisi OA, Nwaorgu OGB, Grandawa HI, Isa A. Fifteen-year review of otologic surgery in Ibadan, Nigeria: Problems and Prospects. Nigerian J Surgical Res. 2002;4(1-2):45-9.

Ahmad BM, Kudi MT. Chronic suppurative otitis media in Gombe, Nigeria. Nigerian J Surg Res. 2003;5(3-4):120-3.

Okafor BC. The chronic discharging ear in Nigeria. J Laryngol Otol. 1984;98:113-9.

George GB, Merchant SN, Kelly G, Swan IR, Canter R, Mckerrow WS. Chronic otitis media. In: Gleeson M ed. Scott-Brown′s Otorhinolaryngology Head and Neck Surgery. 7th ed. London: Edward Arnold; 2008:3397-438.

Adams ME, Hussam K. Tympanoplasty and Ossiculoplasty. In: Flint PW, Haughey BH ed. Cummings Otolaryngology Head and Neck Surgery. 5th ed. PA:Moby Elsevier; 2010: 1999-2005.

Tos M, Stangerup SE, Orntoft S. Reasons for reperforation after tympanoplasty in children. Acta Otolaryngol Suppl. 2000;543:143-6.

Sohil V, Anuja K. Atticotomy, Attic Reconstruction, Tympanoplasty with or Without Ossiculoplasty, Canal Plasty and Cortical Mastoidectomy as Part of Intact Canal Wall Technique for Attic Cholesteatoma. Indian J Otolaryngol Head Neck Surg. 2015;67(2):128-31.

Tos M. Modification of combined approach tympanoplasty in attic cholesteatoma. Arch Otolaryngol Head Neck Surg. 1982;108:772-8.

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.

Shigenobu N, Shin K, Rie N, Norimasa M, Kazunori N, Michael MP. Facial nerve canal dehiscence in chronic otitis media without cholesteatoma. Eur Arch Otorhinolaryngol. 2014;271(3):455–8.

Magliulo G, Colicchio MG, Appiani MC. Facial nerve dehiscence and cholesteatoma. Ann Otol Rhinol Laryngol. 2012;121(10):663.

Trinidade A, Yung MW. The intra-operative incidence of Fallopian canal dehiscence during surgery for cholesteatoma: a prospective case-control study and review of the literature. Clin Otolaryngol. 2014;39(3):138-44.