A Comparative Study on Effect of Different Approaches of Mastoidectomy Related to Recurrence and Hearing Improvement

Abstract

Introduction: Hearing can be impaired by many conditions such as congenital, or due to trauma or infection or any abnormality in conductive pathway, of this infection in middle ear is one of the most common cause of hearing loss in developing countries. So any abnormality in tympanic membrane or middle ear conductive mechanism may cause Conductive type of hearing loss.

The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or flaccida, most likely a result of earlier acute otitis media, negative middle ear pressure or otitis media with effusion. Materials and Methods: A comparative retrospective study was conducted on the patients of unsafe type of chronic otitis media, who had undergone mastoid surgery.

Aim: Aim of this study is to compare the success rate of the different types of mastoid surgeries like modified radical mastoidectomy (canal wall down), intact canal wall mastoidectomy without posterior tympanotomy and intact canal wall mastoidectomy with posterior tympanotomy, in terms of eliminating cholesteatoma and to assess the postoperative hearing improvement in different kinds of surgeries.

Inclusion criteria: Patients having unsafe type of COM.

Exclusion criteria: Patients who were excluded for intact canal wall surgery were,

• Revision ICW cases • More than 1/3rd destruction of posterior canal wall (Intra operative finding) 3.Patients who had severe to profound hearing loss due COM.

Conclusion: Intact canal wall masotidectomy with or without posterior tympanotomy were having better hearing results compared to modified radical mastoidectomy. The advantage of intact canal wall mastoidectomy with posterior tympanotomy are, minimal recurrence rate due to completely removal of disease, and better post op hearing threshold. But intact canal wall mastoidectomy with posterior tympanotomy is technically difficult, it requires good surgical skills. Modified radical mastoidectomy has inherent cavity problem, poor post op hearing as reconstruction with auto graft is difficult and requires lifelong follow up but has the advantage of less recurrence and technically easy to perform. In Intact canal wall mastoidectomy without posterior tympanotomy can give good hearing results as it allows hearing reconstruction and also offers a greater selection of hearing aids but complete eradication of disease might not be possible.