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Does concomitant mastoidectomy improve outcomes for patients undergoing repair of tympanic membrane perforations?
Author(s) -
Hall Joseph E.,
McRackan Theodore R.,
Labadie Robert F.
Publication year - 2011
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21917
Subject(s) - tympanoplasty , medicine , mastoidectomy , chronic suppurative otitis media , surgery , tympanic membrane perforation , cholesteatoma , perforation , materials science , punching , metallurgy
BACKGROUND Although tympanoplasty with or without mastoidectomy is a common procedure, failures of perforation closure are not a rare occurrence. 1 Optimization of the tympanoplasty procedure would lead to improved patient outcomes and increased patient satisfaction. Controversy currently exists amongst otologists regarding the appropriate treatment of tympanic membrane perforations resulting from chronic suppurative otitis media without cholesteatoma. Proponents for mastoidectomy with tympanoplasty for this patient population contend that surgical opening of the mastoid pneumatic system buffers pressure changes in the middle ear according to Boyle’s Law and allows for the debridement of infected tissue and devitalized bone that may not be otherwise effectively treated. Anecdotal and empirical data supporting this theory are prevalent within the literature. However, several recent studies investigating tympanoplasty with or without mastoidectomy refute the claim that mastoidectomy improves otologic outcomes following perforation repair. 2,3 We review the current body of literature in an effort to elucidate the best practice. LITERATURE REVIEW Several studies have retrospectively reviewed outcomes of tympanoplasty with or without mastoidectomy for the treatment of noncholesteatomatous chronic suppurative otitis media (CSOM) (Table I and Table II. Balyan et al. 2 reviewed 323 patients with CSOM. The patients were separated into three groups: group I (n ¼ 53) consisted of patients with draining CSOM treated with tympanoplasty alone, group II (n ¼ 28) consisted of patients with draining CSOM treated with tympanoplasty with mastoidectomy, and group III (n ¼ 242)