Mastoidectomy audit: results of the Royal College of Surgeons of England comparative audit of ENT surgery

Abstract

This paper presents the results of a national comparative audit of mastoid surgery, retrospectively analysing 611 operations by 55 consultants. Confidentiality for both patient and surgeon was assured. For cholesteatoma 80% of mastoidectomies performed were open cavity procedures and for other middle ear disease 58% used an intact canal wall technique. Thirty-two surgeons used only an open cavity mastoidectomy for cholesteatoma during the period of the audit. There was a statistically significantly greater number of wet ears with open cavities than with closed cavities, but the frequency of the operator did not correlate with the dry ear rate. Ten serious complications (facial palsy and dead ear) were recorded. All occurred in open cavity mastoidectomies. The post-operative hearing status was unknown in 40% of patients.

The methodical collection of ear surgery data as a basis for quality control

“…Similarly, the grade C complications presented in Table 5 (0.3% for all surgery) compare to complication rates documented by other institutions [2,14,15,16,20,23,29,35,37,38]. The way the data are presented in this paper is therefore indicative; other formats could also have been adopted.…”

“…Overviews generated from these data provide, for example, improved and up-to-date local patient information [30], a starting point for clinical audit [15,16,32,35] and a basis for quality improvement activities.…”

Canal Wall Down Mastoidectomy-Doctor Dependent for Whole Life?

“…9 Youngs studied the histological features of material from revision cases of mastoidectomy. Their findings include foreign body granuloma, squamous epithelium with acute and chronic inflammation, aural polyp.…”

Hydroxyapatite granules used in the obliteration of mastoid cavities in rats

“…Cholesteatomas can be defined as the presence of skin in the middle ear cavity and mastoid -places where usually there is only respiratory mucosa, thus not sites which are ready to bear keratinized epithelium, from the ventilation standpoint 8 . It has an external matrix made up of keratinized stratified squamous epithelium on a fibro-connective tissue, which sheds itself in lamellae within the space it outlines, filling out and promoting local distension and bone erosion.…”