Day-Case Management of Chronic Suppurative Otitis Media with Cholesteatoma with Canal Wall down Technique Surgery: Long-Term Follow-up

Abstract

The overall number of day-case otologic surgery cases is increasing; however, there is limited experience about performing canal wall down tympanoplasty in patients with chronic suppurative otitis media with cholesteatoma in this setting. The objective of this study was to assess the success of this technique as daycase surgery in terms of results and complications over an 8-year follow up period. We included in this study 42 patients undergoing canal wall down technique tympanoplasty surgery for chronic suppurative otitis media with cholesteatoma performed as day cases during a 2-year period. 30 cases (71.4%) were discharged on the day of surgery, whereas 12 cases (28.6%) were hospitalized and discharged the day after. The principal reasons for failure of discharge on the day of surgery were asthenia (6 cases), vertigo and asthenia (4 cases), undetermined (2 cases). Based on our experience, with a proper preoperative selection, assessment and screening of the patients, mastoidectomy with timpanoplasty for chronic suppurative otitis media with cholesteatoma can be carried out in a day surgery setting with no significant effects on effectiveness of surgery, post-operative symptoms and relapse of disease even in the long term.

Admission Rates Following Day-Case Major Otologic Surgery: A Systematic Review

“…1). After selection based on title and abstract, and subsequent full-text screening, 35 articles discussing 34 studies were considered eligible for further review (2–5,11–41). Cross-reference checking revealed no additional relevant articles.…”

“…The latter speculation is supported when looking at the most frequent reasons for admission: PONV (27%) and late-scheduled surgery (8%). Five studies (5,17,24,28,30) described the presence of an underlying infectious or destructive disease and the effect on PONV, length of surgery and hospital stay. In the study population of Hasan et al (17), 58% had a cholesteatoma whereby the presence thereof was associated with a higher risk of PONV.…”

“…Adequate randomization and treatment allocation, and blinding were not achieved in any of the included studies. Standardization of treatment and outcome measures were achieved in 19 (11,13,(16)(17)(18)20,21,24,(27)(28)(29)(30)32,33,35,(38)(39)(40)(41) and 26 (2,4,5,11,13,(16)(17)(18)(19)(20)(21)(22)24,25,(29)(30)(31)(32)(33)(34)(35)37,38,40,41) of all studies, respectively. In 13 studies (3,4,11,12,(14)(15)…”

“…Mastoid Surgery Fourteen studies (2)(3)(4)(5)(14)(15)(16)(17)19,20,23,24,26,28,30) reported admission rates of 0% to 82% (mean 21%, pooled mean 16%) following day-case mastoid surgery. PONV (n ¼ 59; 27%), vertigo (n ¼ 7; 3%), asthenia (n ¼ 6, 3%), late-scheduled surgery (n ¼ 17; 8%), presence of co-morbidities (n ¼ 8; 4%), and observation required by the anesthetist (n ¼ 8; 4%) were the most common reasons for admission following mastoid surgery.…”

Study of direct cost of care among ENT surgical inpatients at a tertiary teaching hospital

“…8 Ralli G et al concluded that with proper preoperative selection of the patients, mastoidectomy with tympanoplasty can be carried out in a day surgery setting with no significant effects on effectiveness of surgery and post-operative symptoms. 9 Data was entered, studied and analyzed with SPSS version 19. Frequencies, relationship and proportions were generated.…”