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Conservative tympanomastoidectomy
Author(s) -
Cole J. M.
Publication year - 1974
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 - 10.1288/00005537-197405000-00009
Subject(s) - cholesteatoma , medicine , mastoidectomy , surgery , middle ear , ear canal , radiology
The objectives of tympanomastoid surgery are elimination of irreversible middle ear and mastoid disease, usually cholesteatoma, and maintenance or restoration of serviceable unaided hearing. There are a surprising number of techniques described in the literature but in essence they break down into two schools of thought, those who favor an intact posterior canal wall technique in most cases and those who feel that the possibly improved hearing results obtained with an intact posterior canal wall technique do not warrant the additional risks involved. Sheehy recently has reported an incidence of 35 percent persistence or regrowth of cholesteatoma found in mastoid re‐explorations following the intact posterior canal wall technique for management of epitympanic and mastoid cholesteatoma. We believe there are excellent reasons for removing the posterior canal wall routinely in dealing with mastoid cholesteatoma. This technique is far superior in obtaining permanent control of the disease process, usually results in a small trouble‐free mastoid cavity, and does not seriously interfere with reconstruction of a serviceable sound conducting mechanism in the majority of cases. In analyzing the results of 100 consecutive mastoid operations for the period from 1970 through 1972, it was possible to maintain or reconstruct the sound conducting mechanism in 94 percent. In those cases which had preoperative bone conduction of 35 db ISO or better for the speech frequencies, the type and percentage hearing results obtained are presented. Endaural modified radical mastoidectomy combined with tympanoplastic repair at the time of definitive surgery permits maximum visualization of the middle ear space. Because most mastoids which harbor cholesteatoma are sclerotic, small trouble‐free mastoid cavities result from this type of surgery and the open mastoid technique offers the best prospects to the patient for obtaining a dry safe ear without danger of persistent or recurrent cholesteatoma in the mastoid segment. It does not seriously preclude tympanoplastic reconstruction of a functioning sound conduction mechanism. When feasible, tympanoplastic repair should be done at the same time definitive mastoid surgery is done. This can usually be accomplished in one brief hospitalization and a minimum of postoperative visits to the physician's office.