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At least 19 recordsLinked to original sources
PubMed1992

Drill-generated sensorineural hearing loss following mastoid surgery.

Drilling during mastoid surgery may result in temporary noise-induced hearing loss. This has practical implications for both the patient and surgeon. In a prospective study of 40 patients, audiometric testing was done both preoperatively and postoperatively to try to detect any significant hearing loss in the immediate postoperative period. The data were analyzed using the Student's paired t test. No statistically significant difference was found. A sensorineural hearing loss soon after mastoid surgery is not due to the noise generated by the drill. In the event of any hearing loss during this period, other causes should be sought.

Adolescent↗
PubMed1997

Do the complications of mastoid surgery differ from those of the disease?

During mastoid surgery there is a risk to the facial nerve and hearing but at present it is unclear how substantial this risk is. This information is necessary for adequate informed consent to be given, as consent requires information about both the potential risks of the surgery as well as the risks of leaving the disease untreated. The aim of this study is to establish the risks of mastoid surgery and the incidence of complications as a consequence of mastoid disease. The records of all patients undergoing mastoidectomy between 1985 and 1994 were reviewed for preoperative and intra-operative complications. Preoperatively there were 21 (2%) facial nerve palsies, 67 (6.5%) dead ears and 58 (5.7%) intracranial complications of the mastoid disease. If this risk is extrapolated for the population of the Western Cape over a 40-year period (average expected life-span after presentation), the risk of developing a serious complication (facial palsy, dead ear or intracranial) from mastoid disease during this period was 3.8%. The incidence of intra-operative iatrogenic facial nerve palsy was 1.7% (n = 17) and of dead ear was 1.7% (n = 17). Although the comparative risk of developing a severe complication from untreated disease was similar to the risks of surgery (facial palsy, dead ear), the number (58) of intracranial life-threatening preoperative complications presenting in the 10-year period reviewed was significant. These figures provide a base from which otologists can inform patients about the possible risk of mastoid surgery as well as allowing these risks to be compared with the risks of leaving the disease untreated.

Adult↗
PubMed1997

Facial nerve palsy in mastoid surgery.

The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.

Clinical Protocols↗
PubMed2003

Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery.

OBJECTIVES: Despite the utility of intraoperative facial nerve monitoring in reducing the risk of iatrogenic facial nerve injury during neurotologic surgery, its routine use during primary or revision surgery remains controversial. One of the major barriers to its acceptance is cost. This study evaluates the cost-effectiveness of intraoperative facial nerve monitoring during middle ear or mastoid surgery. RESEARCH DESIGN/METHODS: A simple decision analytic cost-effectiveness model and a societal approach were used to evaluate three cohorts of individuals who received (1) intraoperative facial nerve monitoring for both primary and revision middle ear or mastoid surgeries, or (2) facial nerve monitoring for revision surgeries only, or (3) no monitoring for any middle ear or mastoid surgeries. RESULTS: Our results strongly favored the use of intraoperative facial nerve monitoring in all patients undergoing middle ear or mastoid surgery, adding about $222.73 to $528.00 US dollars to the total cost. The strategy to monitor primary and revision surgeries had the greatest effectiveness and lowest cost, with an average quality-adjusted life-year (QALY) of 45.68 at an average cost of $238 US dollars. Facial nerve monitoring in revision patients only had similar QALYs (45.67) and higher costs ($292.1). Finally, the strategy not to monitor had the lowest QALY (45.65) and highest cost ($449.8). The analysis was robust across a wide range of changes in both costs and probabilities. CONCLUSIONS: Facial nerve monitoring is cost-effective, and its routine use should be adopted to reduce the risk of iatrogenic facial nerve injury during otologic surgery.

Cost-Benefit Analysis↗
PubMed1998

Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery.

Hearing results were studied in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery in a private practice setting. A retrospective chart review was performed on 69 patients who underwent surgery from 1991-1995. Twenty-six patients underwent canal-wall-up mastoidectomies, and 43 patients underwent canal-wall-down mastoidectomies. Various types of ossicular reconstruction were performed in patients in both groups. Hearing was evaluated for preoperative and postoperative pure-tone averages, speech-reception thresholds, and air-bone gaps for the various types of ossicular reconstruction. Patients with canal-wall-up mastoidectomies and an intact ossicular chain had an average postoperative air-bone gap of 15 dB, whereas reconstruction of the ossicular chain (regardless of technique) resulted in an average postoperative air-bone gap of 19 dB. Patients with canal-wall-down mastoidectomies and an intact ossicular chain had an average air-bone gap of 15 dB, while all techniques of ossicular reconstruction had an average air-bone gap of 29 dB. Canal-wall-up and canal-wall-down mastoid surgeries in pediatric patients have similar hearing results. Variables other than hearing should be used to make treatment decisions regarding the canal wall in pediatric candidates for mastoid surgery.

Adolescent↗
PubMed1984

Bone conduction evaluation related to mastoid surgery.

The bone conduction threshold changes of 97 patients (100 ears) who underwent mastoid surgery were determined by comparing the last preoperative audiogram with the 1 year postoperative audiogram. Three types of mastoid surgery were evaluated: radical mastoidectomy, modified radical mastoidectomy, and intact wall atticomastoidectomy. The average three speech frequency preoperative bone conduction threshold was 17.4 dB (S.D. 11.5) in the radical mastoidectomy group, 10.1 dB (S.D. 9.6) in the modified radical mastoidectomy group, and 10.7 dB (S.D. 8) in the intact wall atticomastoidectomy group. The difference between the average three speech frequency preoperative bone conduction threshold of the radical mastoidectomy group differed significantly when compared to the modified radical mastoidectomy or intact wall atticomastoidectomy group. The postoperative average three speech frequency bone conduction threshold did not change significantly following the three surgical procedures evaluated.

Adult↗
PubMed2003

Day-case paediatric mastoid surgery.

OBJECTIVE: Children have traditionally been kept in hospital overnight after mastoid surgery, but evidence from the US in adults suggests that a substantial number of patients may be suitable for discharge on the day of surgery. We sought to ascertain the proportion of our children having mastoid operations between February 1994 and December 2000 who were suitable for same-day discharge. We also evaluated some of the factors that prevented discharge the same day. METHODS: A standard proforma was used to record relevant data in 35 children (mean age 10 years 6 months) undergoing consecutive mastoid operations at Mayday University Hospital, London, UK. Operative findings, duration of anaesthesia and time back on ward were recorded as well as details regarding admission, follow-up findings and complications. A bed was booked preoperatively but there was intent to discharge the patient if feasible. RESULTS: Nine out of twelve patients (75%) operated between 1998 and 2000 were suitable for discharge on the day of surgery. The pre-1998 discharge rate was 20%. Only one of the former group of patients underwent a modified radical mastoidectomy in comparison with ten such procedures pre-1998. There was a significant relationship between extent of surgery and in-patient admission. The outcomes of day-case mastoid surgery, in terms of complications rates and overall success rates, were comparable with surgery performed on an in-patient basis. Using correlation analysis, no relationship could be found between duration of anaesthesia and time of arrival back on the ward and in-patient admission. CONCLUSION: Children can undergo mastoid procedures safely and effectively on a day-case basis but should still have a bed booked pre-operatively as the majority will require admission. The main factor related to admission was the mastoid procedure performed. With improvements in surgical and anaesthetic techniques and other advances, operations such as atticotomy may become standard day-case procedures in paediatric patients.

Ambulatory Surgical Procedures↗
PubMed1999

An assessment of the value of the preoperative computed tomography scans prior to otoendoscopic 'second look' in intact canal wall mastoid surgery.

'Second look' surgery following primary intact canal wall mastoid surgery for cholesteatoma is considered mandatory for most cases in modern otological practice. The morbidity of the second look can be reduced by the use of the rigid otoendoscope. Forty-three patients undergoing 'second look' surgery were studied with an average age of 24.7 years. Prior to surgery a computed tomography (CT) scan was performed to assess the anatomy and pneumatisation of the cavity. The mean interval between primary and secondary surgery was 16 months and in all cases CT scans were performed within 6 months of 'second look' surgery. The presence of an opaque mastoid did not correlate with residual or recurrent cholesteatoma. The sensitivity of CT in diagnosing residual or recurrent cholesteatoma was 42.9% with a specificity of 48.3% and a predictive value of 28.6%. These results are explained by the fact that it is radiologically impossible to differentiate between recurrence, scar tissue or fluid with a CT scan. Nevertheless it was possible to inspect the cavity with the otoendoscope even in the presence of an opaque mastoid whether due to scar tissue or residual/recurrent cholesteatoma.

Adolescent↗
PubMed1991

Mastoid surgery at the Red Cross War Memorial Children's Hospital 1986-1988.

Eighty-three children between ages 0-12 years had mastoid surgery in the three year period 1986-88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4-12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2-12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3-12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.

Acute Disease↗
PubMed1981

Effectiveness of prophylactic antibiotic treatment in mastoid surgery.

This article describes a prospective study of the effectiveness of prophylactic antibiotic treatment in preventing infection following mastoid surgery. Seventy-two patients who underwent surgery for chronic middle ear disease served as the basis for this study. Bacteriologic findings from middle ear discharge, showing aerobic and anaerobic bacteria, are reported. The patients were randomly classified into two groups, one undergoing surgery with preventive antibiotic treatment with clindamycin and gentamycin and the other undergoing surgery without antibiotic therapy. The early postoperative inflammatory complications are presented. No significant differences were found in the incidence of these complications between the two groups. In view of the results, the effectiveness of preventive antibiotic treatment in mastoid surgery is questioned.

Adolescent↗
PubMed1991

Mastoid surgery in childhood.

The presenting features and operative findings in 105 patients aged 16 years or less undergoing mastoid surgery are reviewed. In 94% surgery was for chronic otomastoiditis, usually acquired, and associated with cholesteatoma in 64%. Post-operative otorrhoea persisted beyond 6 months in 44% and contralateral disease required some form of surgical procedure in 20%. Post-operative hearing thresholds were improved or unchanged in the majority of patients, most of whom underwent cortical or modified radical mastoidectomy. An improvement in the therapeutic results of mastoid surgery in childhood is clearly necessary, but requires a greater understanding of the aetiology of chronic middle ear disease.

Adolescent↗
PubMed2000

[Clinical analysis of facial nerve palsy in middle ear and mastoid surgery in 23 cases].

OBJECTIVE: To investigate the cause, the prevention and the therapy of facial nerve palsy(FNP) which induced by the operation of middle ear and mastoid surgery. METHOD: A series of 1032 cases undergone middle ear and mastoid surgery were reviewed between 1976 and 1991. RESULT: 23 cases FNP were identified. All were incomplete and peripheral. 13 cases of them were performed decompression of facial nerve. 6 cases were cure, 4 cases on the mend and 3 cases no effect after operation. 10 cases were treated by conservation, 5 cases were cure, 3 cases on the mend and 2 cases no effect. CONCLUSION: If the facial paralysis occurs during the operation, which means that facial nerve is damaged, except hard-stuff reason. Exploration should be done at once. If facial paralysis occurs later, conservative therapy should be selected at first. If facial paralysis is still not on the mend 1 month of postoperation, one should be done exploration of facial nerve.

Adolescent↗
PubMed2004

Paediatric small cavity mastoid surgery: second look tympanotomy.

OBJECTIVE: Following surgery for retraction pocket/cholesteatoma there is risk of residual disease, after canal wall up surgery a second look tympanotomy is routinely recommended. After canal wall down (CWDM) surgery this is not routine. In certain situations the senior author recommends second look tympanotomy. This report examines the outcome of this management paradigm applied to small cavity mastoid surgery for children. METHOD: A retrospective review of small cavity mastoid surgery for children with cholesteatoma or discharging retraction pocket disease. The primary procedure and surgical findings at second look tympanotomy are reported as well as the pre- and 1 year post-operative air and bone conduction thresholds and air-bone gap averaged across frequencies 0.5, 1, 2 and 4kHz and the mean pre- and post-operative bone conduction threshold at 4kHz. A Student t-test was used to compare hearing results. RESULTS: Forty five were children reviewed at 1 year. Twelve (27%) were recommended second look tympanotomy, of which 10 had surgery; all were free of residual disease. At second look two children had ossiculoplasty performed, four had adhesions divided. Six children had formed a myringostapediopexy after their first surgery. The mean pre-op bone conduction threshold was 6.3dB for those having single stage surgery and 5.6dB for those having a second look and the post-operative thresholds were 7.8 and 10.2dB, respectively. The mean preoperative air conduction threshold was 32.6dB for single stage surgery and 31.1dB for staged surgery and at 1 year 29.2 and 40.8dB. This was a significant difference. After second look, the air conduction threshold was 34.5dB, and not significantly different from those who had single stage surgery. The mean pre-treatment 4kHz bone conduction threshold was 6.3 and 5.6dB for single stage surgery and second look tympanotomy and after surgery, respectively, 9.8 and 14.5dB. These changes are not statistically significant. CONCLUSION: The small cavity mastoidectomy approach allows meticulous removal of disease from the middle ear and for certain indications second look tympanotomy is recommended. Planned second look tympanotomy has demonstrated excellent early disease control as well as allowing timely management of any pathology affecting the middle ear sound transformation mechanism.

Adolescent↗
PubMed1980

The history of mastoid surgery.

Adam Politzer wrote this article on the history of mastoid surgery for inclusion in Volume II of his History of Otology, Enke Verlag, Stuttgart, 1913. Politzer reviews the decades before antibiotics when the simple or complete mastoidectomy was performed in cases of acute mastoiditis in which abscess formation was suspected; such timely surgery after prevented extensive osseous destruction and also often-fatal meningitis and sinus thrombosis. So-called "radical" surgery began when surgeons realized that simple exposure of the antrum was inadequate to control chronic infection involving the middle ear, ossicles, and meatal walls. "Modified radical" surgery evolved from the attempt to preserve hearing, canal plasty from the attempt to prevent postoperative canal stricture. Politzer describes the surgery designed to close the tympanic ostium of the Eustachian tube and the application of skin grafts to the operative sites.

Europe↗
PubMedDate not supplied

Probe-tube microphone measures in patients with open-mastoid surgery: real-ear-to-coupler differences and real-ear unaided responses.

Real-ear-to-coupler differences (RECDs) and real-ear unaided responses (REURs) were measured using a probe-tube microphone system in 15 patients who underwent open mastoid surgery. The results show that RECDs are significantly smaller at higher frequencies (1.5, 2.0, 3.0, 4.0 and 6.0 kHz) in mastoid ears. The intrasubject variability of RECDs measures in these patients is on average 2.6 dB larger than for controls. For REURs, mastoid surgery significantly reduced the mean peak resonant frequency without affecting the amplitude and bandwidth. In operated ears, mean resonant frequency is by a factor of 1.4 lower than that for normal ears. Reduced responses (negative gains) at frequencies above the resonance peak occurred in 7 out of the 15 patients. These reduced responses corresponded to the smaller RECD at the middle and high frequencies. The results support the need for individual RECD measures to be made in operated ears instead of using average values from normal subjects. Otherwise, real-ear measures of the aided response should be made for each patient with open-mastoid cavity and the fitting should be done in terms of the target response at the eardrum rather than by defining a target insertion gain.

Adolescent↗
PubMed1989

Open-cavity mastoid surgery: its effect on the acoustics of the external ear canal.

Temporal bone studies have demonstrated that a modified radical mastoidectomy changes the resonant characteristics of the external auditory canal, but the effect has not been reported in patients. In 12 patients, performing open-cavity mastoid surgery for cholesteatoma changed the mean peak resonant frequency of the external ear canal from 2.5 to 2.2 kHz (p less than 0.02). This is in comparison with creating a modified radical mastoid cavity in 6 temporal bones which changed the mean peak resonant frequency of the external ear canal from 3.9 to 1.9 kHz. It is concluded that open-cavity mastoid surgery in patients changes the acoustics of the external ear canal less than in temporal bone studies.

Acoustics↗