Sampath Kumar Singh Katewad1, Rajesh Kumar Avuluri2, Mahendra Kumar Maimal3
BACKGROUND
The main aims in doing surgery for chronic otitis media are: 1. Complete clearance of progressive disease from its site and form dry and well-epithelialised cavity. 2. Prevention of recurrent and residual cholesteatoma achieved by modifying the anatomy of tympanomastoid compartments. 3. Hearing improvement by reconstructing the ossicles and tympanic membrane. The main indication for revision surgery is failure to achieve above said aims by previous surgeon. The aim of our study was to identify the causes of recurrent disease and the factors that helps in chronic otitis media surgery to minimise the revisions & report the results of revision mastoidectomy.
MATERIALS AND METHODS
In this study, thirty patients are selected and operated for revision mastoidectomy surgery at our institute during the period from May 2013 – Dec 2015. These cases were analysed retrospectively, patients who had discharging ear with the history of previous intact canal wall and canal down mastoidectomy surgeries were selected for this study.
OBSERVATION AND RESULTS
In this study, the common age group of patients who underwent revision surgery - 8-46 yrs. (mean 19 yrs.). Majority of patients are female, 16 cases (53.33%); and males 14 cases (46.66%). Revision mastoidectomies were applied to 12 cases (40%) of previous canal wall up mastoidectomies and 18 cases (60%) of prior canal down mastoidectomies. 60% of cases had residual/recurrent cholesteatoma which was the most common finding seen. While in 33.3% cases patient had only chronic granulations. The most frequent site of cholesteatoma was mastoid antrum/mastoid cavity seen in 73% followed by attic 42.3% and mesotympanum in 40% of cases. The common failure in primary surgery was inadequate clearance of diseased mastoid air cells - 48%, high facial bridge - 48%, stenotic meatoplasty - 40%, incomplete removal of buttress - 30%. Tympanic membrane perforation - 6.66% of cases with poor architecture of mastoidectomy were seen.
CONCLUSION
Residual/recurrent cholesteatoma, high facial bridge, improper removal of mastoid air cells, incomplete removal of buttresses, improper saucerisation of mastoid cavity and narrow meatoplasty are causes for discharging cavity. Thorough knowing of the anatomy & behaviour of disease, identify the causes of primary surgical failure and experience of the surgeon are the key factors in outcome of results. Revision mastoidectomy surgery has high success rate in obtaining dry and epithelialised ear by experienced surgeon.
