Mastoidectomy for chronic serous otitis media

Abstract

THE purpose of this paper is to show that satisfactory results following mastoidectomy can be obtained for the problem of chronic serous otitis. The success of the simple mastoid operation or mastoidectomy with facial recess approach and the subsequent increased aeration of the mastoidantral-attic-middle-ear complex is to be suggested when the repeated use of myringotomy tubes alone is not the answer to chronic serous otitis. It is chronic negative pressure due to eustachian tube dysfunction that leads to irreversible mastoid disease.Seven cases of mastoidectomy for chronic serous otitis media are presented. All cases had adequate conservative medical and surgical treatment over a period of years for chronic serous otitis before mastoidectomy was considered. The clinical history, as well as lateral mastoid X-ray, was used in diagnosing irreversible mastoid disease. IntroductionThe standard treatment of chronic serous otitis media has not always proved satisfactory. The use of antibiotics, decongestants, allergic workup (including desensitization), politizeration techniques, aspirations, tubes and other modalities for the relief of chronic serous otitis based on eustachian tube obstruction has in some cases only prolonged the changes associated with chronic serous otitis. The possibility of intractable mastoid disease with its effects on the tympanic membrane and hearing has at times only been given cursory examination. The technique of mastoidectomy in the treatment of chronic serous otitis media is controversial but the articles of Austin (1977) and Sheehy et al (1969) suggest that the technique has merit.Mastoidectomy increases the volume of the mastoid bone and leads to physical changes in the transmission of sound which improve hearing. The following seven cases did not respond in the usual way to standard treatment and required mastoidectomy. Contributing factors such as deviated septum, chronic sinusitis and/or allergy in chronic eustachian tube dysfunction were present and adequately treated as soon as diagnosed including repeated tube insertions. The underlying mastoid disease related to chronic negative pressure in the middle-ear-atticantrum-mastoid complex was not altered permanently by the repeated use of ventilation tubes in these cases.

Infectious complications and ventilation tubes in pediatric cochlear implant recipients

“…One argument against VT placement is that ears undergoing CI may be protected from future infections due to the mastoidectomy intrinsic to the procedure, on the theory that the latter provides an “air reservoir” to buffer against middle ear pressure changes. This concept arose after several older studies showed improved outcomes in chronic TM perforations and chronic refractory OM after mastoidectomy . By contrast, several more recent studies have failed to find benefit from mastoidectomy for either chronic OM, or for OM in cochlear implant children …”

The Influence of Mastoidectomy on Natural History of Secretory Otitis Media in Cochlear Implant Children

“…In recurrent cases with no resolution after repeated insertions of ventilating tubes, the use of steroids for a limited time, with or without performing adenoidectomy, was described [6] . In persistent cases that do not respond to the usual therapy, some authors recommend performing mastoid surgery [7][8][9] . The widespread assumption is that the contribution of mastoidectomy in treating SOM is due to the enlargement of the mastoid volume and, therefore, improving ventilation of the middle ear [9] .…”

“…In persistent cases that do not respond to the usual therapy, some authors recommend performing mastoid surgery [7][8][9] . The widespread assumption is that the contribution of mastoidectomy in treating SOM is due to the enlargement of the mastoid volume and, therefore, improving ventilation of the middle ear [9] . Sade et al [10] the theory that the amount and composition of middle ear gas depend primarily on the function of middle ear and mastoid mucosa.…”

The influence of cochlear implant surgery on the natural history of secretory otitis media

“…According to the assumption that 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.08.064 the contribution of mastoidectomy in treating SOM is due to enlargement of the mastoid volume, some authors recommend performing mastoid surgery in persistent cases of SOM [6,7]. Sade [8] presented the theory that the gas exchange in the middle ear and mastoid depends mainly on functioning mucosa and on its blood vessels.…”