Radical revision mastoidectomy for chronic otitis media without cholesteatoma: the relevance of excenteration of all rest cells

Abstract

Patients who, despite treatment, suffer persistent chronic otitis media (COM), a radical cavity and a hearing loss of more than 55 decibels for more than five years, can be classified as having an ‘endstage’ COM. It is generally agreed that retained infected residual cell tracts or a too small meatus are common causes for failure of surgery for COM. Radical revision mastoidectomy (RRM) aims to remove all residual cell tracts in the mastoid, in the middle-ear cleft, around the labyrinth and around the Eustachian tube. The mastoid cavity is obliterated with a pedicled muscle flap. Thus the mastoid cavity is reduced and selfcleansing is improved. The first 16 consecutive patients who underwent a RRM for ‘endstage’ COM were included in this study. In about 80 per cent the treatment resulted in a dry ear. We, therefore, conclude that RRM is an effective and safe method for treating ‘endstage’ COM.

Long-term outcome of modified radical mastoidectomy

“…6 Similar principles have been described by many, including Fisch, with the goal being to achieve maximal reduction of mastoid cavity volume and the obliteration of bony pockets. 6,7,17 The cavity should have flowing contours with an absence of acute angles, which may act as barriers to epithelial migration. Such attention to surgical detail is essential if one is to create a trouble-free and maintenance-free cavity.…”

Chronic suppurative otitis media: A review

“…In cases of therapy-resistant CSOM radical mastoidectomy may be considered, with or without mastoid obliteration [111][112][113][114]. In one retrospective case study of 16 patients (average age 44 years) who had undergone a radical revision mastoidectomy, 80% obtained a dry ear (95% CI, 60-99) [111].…”

“…In one retrospective case study of 16 patients (average age 44 years) who had undergone a radical revision mastoidectomy, 80% obtained a dry ear (95% CI, 60-99) [111]. In another case-control study of 30 patients with CSOM who had been managed by revision mastoidectomy with mastoid obliteration using a temporoparietal fascial flap, 96% (95% CI, 89-100) had a dry ear at 12 months follow-up versus 10% (95% CI, 1-21) of 30 conservatively treated patients with CSOM [114].…”

Long-term follow-up evaluation of mastoidectomy in children with non-cholesteatomatous chronic suppurative otitis media

“…Due to unresponsiveness and relapses surgical intervention may be the ultimate choice, i.e. myringoplasty, exploration of the middle ear and mastoidectomy [15][16][17]. However, the beneficial long-term effects of surgery in children with CSOM seem controversial, especially as regards mastoidectomy [18][19][20].…”