Mastoid Surgery For The Chronic Ear: A Ten Year Review

摘要

Background: mastoidectomy can be a life saving procedure in cases of complications of chronic suppurative otitis media. The aim of this study was to review the indications and outcome of mastoidectomy in our environment. Methodology: This is a retrospective chart review of all mastoid surgery between 1997 and 2006 in university college hospital, Ibadan. Results: The study comprised of 25 surgical procedures in 23 subjects, 9 males and 14 females (m:f = 1:1.5). The peak age incidence was 21 – 35 years constituting 44%, in age range 3 to 64 years, mean of 26 years (sd = 25.00years). Otorrhoea and otalgia were the main presenting feature, 21(84%). Duration of disease before presentation was more than 10 years in 8(32%). Pure tone audiometry revealed hearing loss in 16(64%). the commonest indications for surgery was mastoiditis /mastoid abscess in 19(76%). Modified radical mastoidectomy was done in 48% with type iii tympanoplasty in 64%, postoperative appreciable gain in hearing was noted in 13(52%). Conclusion: Early referral of patients and detailed follow up is essential to minimize the sequelae of hearing loss and persistent discharge. Introduction Mastoidectomy can be a life saving procedure in cases of mastoiditis, persistent chronic suppurative otitis media (CSOM) and intracranial complications of chronic suppurative otitis media 1 . However it can be accompanied with fatal complications such as facial nerve palsy, injury to the venous sinuses and CSF leakage. An understanding of mastoid techniques allows the surgeon to individualize the procedure appropriate for each patient and optimize outcome of surgery 2 . The goal of any ear surgery is to create a dry, safe ear, to preserve or restore functional hearing as much as possible and to prevent intracranial complications 2,3 . Multiple mastoid procedures exist, each with their own indications, advantages, and disadvantages. It can be cortical, modified radical or radical mastoidectomy 4 ; all with their different indications. The need for mastoidectomy when strongly indicated should be recognized by Otorhinolaryngologist. However, mastoidectomy can be defined as the surgical procedure of exenterating the mastoid air cell of disease 4 . The aim of this study was to review the indication and outcome of mastoidectomy in our environment. Material and Methods This is a retrospective study of all patients that had mastoid surgery between 1997 and 2006 in University College Hospital, Ibadan. The case records of these patients were reviewed and the data retrieved include the demographic data, their complaints of the patients and duration of the complaints, the clinical findings, the indication for the surgery the surgical finding, as well as the wound progress post operatively. All these were entered into a computer soft ware SPSS 11.0 and the data were analysed. Results The study comprised of 25 surgical procedures in 23 subjects, 9 males and 14 females (M:F = 1:1.5). The peak age incidence was 21 – 35 years constituting 44%, however it ranged between 3 to 64 years, mean of 26 years (SD = 25.00years). Otorrhea and otalgia were the main presenting feature, 21(84%), others are hearing loss 2(8%) and tinnitus 1(4%), aural polyp in 5(20) and facial palsy in 1(4%). The duration of disease before presentation was more than 10 years in 8(32%) of the patients presented after 10years of onset of symptom 6(24%) between 1-10years and 5(20%) between 1-3months, 2(8%) between 3-4weeks, 2 between 3-6months and only 1(4%) presented within one week of onset of symptom.Pure Tone Audiometry revealed hearing loss in 16(64%). The indications for surgery and clinical diagnoses were mastoiditis/mastoid abscess in 19(76%), aural polyp 5(20), mastoid abscess 4(16%), cholesteatoma 2(8%) and meningitis 1(4%).