Authored by Lugo Machado JA
Abstract
Objective: To describe the clinical characteristics and
results obtained in patients who underwent repair of tympanic
perforation secondary to chronic non-cholesteatomatous otitis media with
sclerotic mastoid bone, with and without mastoidectomy.
Material and methods: comparative cross-sectional study, with a
non-probabilistic sampling by consecutive series of cases. We reviewed
the
files of patients who meet the inclusion criteria in the period from
January 2015 to May 2016. Data was collected such as; age, sex, state of
origin,
history of smoking, cause of perforation, duration of dry ear, data to
otoscopy, presence of trans operative and postoperative otorrhea, state
of the
mucosa, presence of tympanosclerosis or miringoesclerosis, perforation
or retraction of the graft.
Results: A total of 48 patients were selected; 31 of the
female sex and 17 of the male sex, with an average age of 43.25 years,
the follow-up was
3 months. When comparing the group of patients with and without
mastoidectomy, no statistically significant difference was found in the
success of
the surgery (graft perforation RR 1.2, p 1, postoperative otorrhea RR
2.26, p 0.68 and graft retraction RR 0.76, p 1). We found that the
characteristics
during and before surgery did not influence the final result, presenting
an overall average of 94% of graft integration.
Conclusion: The mastoidectomy shows no additional benefit in
tympanic membrane repair, the characteristics during and prior to
surgery did not influence the final result.
According to the time of evolution, otitis media is subdivided
into; Acute when the process lasts less than 3 weeks. Subacute
when the infection lasts from 3 weeks to 3 months and Chronic
when the disease lasts for more than 3 months [1]. Chronic otitis
media is an insidious, slow-moving mucoperiosteal inflammatory
process that affects the structures of the middle ear cavity, mastoid
cells and eustachian tube1. It may precede suppurative processes
and affect the tympanic membrane with perforation or scarring
(neotimpano or tympanosclerosis) and even with osteolytic lesions.
According to clinical findings, chronic otitis media is classified as
cholesteatomatous or non-cholesteatomatous [1].
The chronic cholesteatomatous otitis media can be
a. Congenital, which is less frequent, it is diagnosed when
there is embryogenic residue of scaly tissue in the tympanic
cavity.
b. Acquired, which in turn can be primary or secondary [1].
Tympanic perforation can have other etiologies besides the
infectious one, such as traumatic, neoplastic or iatrogenic defects
and in turn the perforation sites can be marginal or central,
whose nomination depends on the existence or not of peripheral remnant
at the site of the perforation [2,3]. Chronic otitis media
is a disease frequently seen throughout the world, it is not known
exactly the incidence of this entity in the general population, it is
estimated that 0.5% of people over 15 suffer from any of its forms
suppurative, and around 4% some type of tympanic perforation,
the distribution between sexes and ages (in the adult stage) is
apparently homogeneous1. Malnutrition, lack of hygiene, poor
housing, and high population density are factors that are associated
with a higher incidence of middle ear infections [4].
Although the incidence of the disease and its complications
have decreased due to the widespread use of antibacterial agents,
in order to completely cure the disease, surgical means are
necessary in some cases [1,5]. However, the surgical treatment of
chronic non-cholesteatomatous otitis media is still controversial,
it is well accepted that the main objective of the operation is to
obtain a permanently dry ear and close the perforation, with other
objectives being to remove the pathological tissues, restore the
normal functions of the middle ear and eradicate the disease from
the mastoid cells [5,6]. Tympanoplasty with mastoidectomy has
been identified as an effective method for the treatment of chronic
ear infection resistant to antibiotic treatment, but the effect of
mastoidectomy in patients no evidence of active infectious disease
remains highly debated and unproven [6]. Some of the indications
for mastoidectomy are the eradication of chronic infection and as
an approach for various neuro- logical procedures [6].
Mastoidectomy was first described by Louis Petit in the
1700s, although the concept did not gain acceptance until 1958,
with cortical mastoidectomy popularized by William House [6].
Tympanoplasty is a common surgical procedure to close the
perforations of the tympanic membrane [7]. The main objectives
of tympanoplasty are to obtain a stable intact tympanic membrane,
eradicate middle ear disease and to improve hearing [7]. The
modern tympanoplasty was introduced in 1950 by Zollner and
Wullstein, since then, different techniques were developed for
the repair of the tympanic membrane, being Tabb and Shea who
performed the first medial placement of the graft in reference to
the hammer and the rest of the membrane tympanic [2]. The results
of tympanic membrane repair, although generally favorable, can
vary significantly depending on multiple factors, including age,
active infection at the time of surgery, eustachian tube dysfunction,
variations in surgical technique. , the size and location of the
perforation; cause of the perforation, the condition of the ossicular
chain and the mucous membrane of the middle ear, the condition
of the contralateral ear, the experience of the surgeon, the duration
of the dry ear period prior to surgery, smoking and the presence of
myenterosclerosis or tympanosclerosis [7-10].
Nowadays, two classic methods are applied in tympanoplasty
that includes underlay and overlay 2 techniques. In the underlay
method, the graft is medial to the hammer and the rest of the
eardrum and in the overlay technique, the graft is placed lateral to
the annulus and the fibrotic layer of the tympanic membrane [2].
The underlay technique is more recommended for subsequent
perforations, has less risk of lateralization, and more acceptable
success rate and the technique of overlay, not only is suitable for
all types of perforations, but also saves the volume of the middle
ear, has a good success rate especially in large and previous drilling
[2]. The definition of success after tympanoplasty is not well
established, but most authors refer to it as; the integrity of the
graft or the tympanic membrane, the increase in the postoperative
auditory threshold or the preservation of the hearing, the complete
healing, which is manifested by the graft located in the correct
anatomical position, without atelectasis or presence of otorrhea
and recreation of the aeration of the middle ear [3,8,11].
Tympanoplasty by using temporary fascia as a graft material
with different techniques has a success rate that ranges from 75%
to 90% and even much higher in small perforations (less than 25%),
because of its accessibility and its characteristics of elasticity and
thickness, is the ideal material to rebuild the tympanic membrane,
this is because the temporal fascia has no or low metabolic activity,
coupled with a low viability that facilitates the growth of the
medium fibrous layer of the membrane tympanic membrane and
results in the formation of very strong neotympanics [12,13]. The
contribution of mastoid pneumatization remains controversial,
and the role of mastoidectomy in the treatment of perforations
of the tympanic membrane continues to be the subject of debate,
particularly in cases of chronic suppurative otitis media in the
absence of cholesteatoma [7].
Some authors think that mastoidectomy is justified in case
of chronic suppurative otitis media that have been refractory to
antibiotic therapy, others have argued that the closure of tympanic
membrane perforations and the elimination of chronic otorrhea
can be achieved effectively when performs tympanoplasty with or
without mastoidectomy [14,15]. Many otolaryngologists continue
to routinely perform mastoidectomy with tympanoplasty, arguing
that surgical aeration of the mastoid will improve the results,
providing a means that can dampen pressure changes in the middle
ear according to Boyle’s law, improve drainage of the middle ear
and mastoid cells and in addition, it can allow surgical debridement
of infected and devitalized tissues that can lead to diseases of the
persistent middle ear [5,7].
The functional advantage of a large pneumatized mastoid
cavity was suggested for the first time by Holmquist and Bergstrom
and Ingelstedt, et al. and, later, it was motivated by Sade, et al. and
Richards, et al. They theorized that when a well-pneumatized
mastoid cavity communicates well with the middle ear, it acts
as a buffer system to reduce the impact of pressure changes
experienced by the middle ear, this allows patients with tubal
dysfunction Intermittent eustachian tolerate better the negative
pressure generated by periods of malfunction of the Eustachian
tube [14]. Some studies show that the volume of the mastoid cells
is indirectly related to the predisposition of the middle ear to
certain pathological conditions [16]. Holmquist reported that the
myringoplasty success correlated directly with the volume of the
mastoid air chamber, taking into account only 22% of Successful
closure of the perforations of the tympanic membrane when the
volume of the mastoid air chamber was <5 cm2 [15].
Some other publications show that a cavity does not function
as a pressure absorber and, furthermore, that the high negative
pressure is caused, not by the diffusion of gases, but by evacuation
of the ear during inhalation in this sense, a large cavity does not
offer no benefit at all [15]. Furthermore, it has also been shown
that removal of the mastoid cavity reduces residual infection and
recurrent cholesteatoma and is associated with fewer secondary
operations and improve functional outcome in addition to removing
the mastoid cavity it alters the exchange of CO2 through the mucosa
of the middle ear cavity, and this in turn can reduce the negative
pressure in the graft [17].
Some other authors recommend not routinely done
mastoidectomy in patients with chronic otitis media without
cholesteatoma the risks caused by mastoidectomy as is
sensorineural hearing loss may be due to trauma milling, meningitis
that can occur due to trauma dura mater the zone of the tympanic
or mastoid tegmen, massive hemorrhage that can occur due to
trauma to the sigmoid sinus and facial nerve injury [5]. It has also
been suggested that mastoidectomy is not only unnecessary in the
treatment of non-cholesteatomatous chronic suppurative otitis
media, but also increases the risks of patients with little or no
significant advantage in the clinical outcome [14].
Anecdotal evidence and empirical has resulted in the common
practice of making mastoidectomy with tympanoplasty for the
treatment of tympanic membrane secondary to chronic suppurative
otitis media colesteatomatosa [18]. Como not evidenced in the
literature, tympanoplasty alone may be sufficient to repair of
uncomplicated simple tympanic membrane perforations [18].
On a systematic review that was conducted in 2013 by Steven J.
Eliades of a patient with chronic non-cholesteatomatous otitis
media who underwent only tympanoplasty or mastoidectomy with
tympanoplasty, it was concluded that there is no additional benefit
in performing mastoidectomy together with tympanoplasty in
uncomplicated tympanic perforations, but patient with tympanic
perforations more complicated if they can benefit from the addition
of mastoidectomy to tympanoplasty [7].
Another retrospective study conducted in 2015 by Rıza Dündar
included 146 patients who underwent tympanic membrane
repair divided into 2 groups; one where only timoanoplasty was
performed and another where mastoidectomy plus tympanoplasty
was performed, concluded that mastoidectomy does not create
statistically significant differences in the success of the graft and the
postoperative hearing results, otherwise it prolongs the duration
of the surgery, increase the costs and risks to which the patient is
subjected [5].
The study was carried out by reviewing the complete files of
the patients with the diagnosis of non-cholesteatomatous chronic
otitis media who underwent mastoidectomy plus tympanoplasty or
only tympanoplasty treated in the Medical Unit of High Specialty
No.2 and who met the criteria of selection, during the period
of time comprised between January 2015 to May 2017 by the
otolaryngology medical team. This work was subject to evaluation
and authorization by the hospital committee. Data were taken such
as age, sex, state of origin, history of smoking, cause of perforation of
the tympanic membrane, duration of dry ear prior to surgery, trans
operative otoscopy, presence of otorrhea at the time of surgery,
state of mucosa at the time of surgery, presence of tympanosclerosis
or miringoesclerosis in the operated ear, presence of postoperative
otorrhea, presence of perforation or retraction of the graft.
Statistical analysis
The data was collected in an Excel spreadsheet. We use
measures of central tendency and dispersion for the quantitative
variables. We use frequency and percentages for qualitative
variables. We look for significant difference between the variables
of the groups, which will be determined according to the realization
or not of mastoidectomy, for this we will use Ch2. We compare the
variables in related groups (before and after the intervention) by
Mc Nemar’s test to analyze significant difference before and after
the intervention. For the comparison of the quantitative variables
as time of evolution between the two groups we used Student’s T
or Mann Whitney U according to the distribution of the data. The
analysis was carried out with the statistical package SPSS version
21 in English.
The follow-up of the patients was 3 months after the surgical
procedure. A total of 48 patients were selected for the study; 31 of
the female sex and 17 of the male sex, their average age was 43.25
years, with a minimum of 20 years and a maximum of 76 years.
With respect to feminine gender in 33% I was performed only
tympanoplasty and 31% mastoidectomy with tympanoplasty, male
11% to be performed only tympanoplasty and 25% mastoidectomy
with tympanoplasty, without significant difference (p 0.13).
Regarding the federative entity of origin 54% (26 patients) were
from the state of Sinaloa, 40% (19 patients) from Sonora, 4% (2
patients) from Baja California Sur and 2% (1 patient) from Baja
California Norte The right ear was the one that was most often
operated with 60.4% compared to the left ear with 39.5% (Graph
1).
As indicated in (Table 1) regarding the characteristics prior to
surgery, of the total of patients with mastoidectomy, 15 surgeries
were in the right ear and 12 in the left ear and of the patients
without mastoiectomy, 14 surgeries were in the right ear and 7
in the left ear, showing no significant difference (p 0.43, OR 0.6, CI
0.19-2.04). Within the group of patients with mastoidectomy,
13 (27%) patients had a perforation size less than 50% and 14
(29.1%) patients greater than 50%, and in the group of patients
without mastoidecimia 9 (18.7%) had perforation. less than 50%
and 12 (25%) greater than 50%, without showing a significant
difference when both groups are compared (p 0.71, OR 1.23, CI
0.39-3.9). Of the patients with mastoidectomy, 4 (8%) patients
had 2 months or less with dry ear prior to surgery and 23 (47.9%)
patients had more than 2 months with dry ear prior to surgery, as
for patients without mastoidectomy, 1 (2%) only patient had dry
ear less than 2 months and 20 (41.6%) patients had dry ear more
than 2 months, without significant difference between both groups
(p 0.36, OR 3.47, IC 0.35 -33.7).
A close to the cause of tympanic perforation in the group
of patients with mastoidectomy in 26 (54.1%) patients was of
infectious origin and only 1 (2%) was of traumatic origin, in the
group without mastoiectomy 20 (41.6%) were an infectious origin
and only 1 (2%) of traumatic origin, without showing significant
differences (p 0.85, OR 0.76, CI 0.04-13). When investigating the
history of smoking only 1 patient in the mastoidectomy group
with tympanoplasty had it and 1 patient in the group without
mastoiectomy referred it, without showing significant difference (p
0.85, OR 0.76, CI 0.04-13).
We compared both groups the variables of findings during
surgery; 15 (31.5%) patients in the group with mastoiectomy
had inflammatory mucosa and 12 (25%) had normal mucosa and
only 2 (4%) patients in the group without mastoidectomy had
inflammatory mucosal status and 19 (39.5) %) normal, showing
significant difference (p 0.001, OR 0.08, IC 0.01-0.43). In 4 (8%)
patients in the group with mastoidectomy they presented otorrhea
at the time of surgery and only 1 (2%) in the group without
mastoidecotmia, without showing significant difference (p 0.36,
OR 3.47, CI 0.37-33.7). In patients with mastoidectomy 22 (45.8%)
the technique was used overlay and in 5 (10.4%) the technique
underlay, and in the group without mastoidecotmia in 18 (37.5%)
the technique was used overlay and in 3 (6.2%) the underlay
technique, without showing significant difference (p 0.69, OR 0.73,
CI 0.15-3.4).
In 4 (8.3%) patients in the group with mastoidectomy they
presented tympanosclerosis and only 1 (2%) in the group without
mastoidectomy, without showing significant difference (p 0.36, OR
3.47, CI 0.35-33-7). In 10 (20.8%) patients had miringoesclerosis
in the group with mastoidectomy and 11 (22.9%) in the group
without mastoidectomy, without showing significant difference (p
0.28, OR 0.53, CI 0.16-1.7) (Table 2). Both groups were confronted
on postoperative characteristics, in terms of graft perforation only
2 (4%) patients presented it in the mastoidectomy group and
only 1 (2) patient in the group without mastoidecomia, without
showing significant difference (p 1 , RR 1.2, CI 0.13-18.9), in 4
(8.3%) presented postoperative otorrhea in the group of patients
with mastoidectomy and 2 (4.1%) patients in the patient group
without mastoidectomy without showing significant difference (p
0.68, RR 1.21 , CI 0.64-2.28), only 1 (2%) presented retraction of the
graft in the mastoidectomy group and 1 (2%) in the group without
mastoidectomy, without showing significant difference (p 1, RR
0.76, CI 0.04-13).
As shown in (Table 3), where we compared patients with and
without mastoidectomy in terms of the characteristics prior to
surgery and its association with the final result, we observed that
there is no significant difference in terms of the ear operated on
in patients with mastoidectomy (ear right: 11 successful and 4
unsuccessful, left ear: 10 successful and 2 unsuccessful, P 0.66,
OR 0.55, IC 0.08-3.68), and without mastoidectomy (right ear:
11 successful and 3 unsuccessful, left ear: 6 successful and 1 not
successful, P 1.0, OR 0.61, CI 0.05-7.24) comparing both groups
there is no significant difference Pt 0.71, ORt 0.58, ICt 0.13-2.63.
The size of the tympanic perforation showed no significant
difference in patients who underwent mastoidectomy (<50%,
13 successful and none unsuccessful,> 50%, 8 successful and
6 unsuccessful) with a P 0.01, OR 1.75, IC 1.11 -2.75, no, so in
patients who did not undergo mastoidectomy (<50%, 7 successful
and 2 unsuccessful,> 50%, 10 successful and 2 unsuccessful)
with a P 1.0, OR 0.70, CI 0.07-6.22, comparing both groups there
was no significant difference in the final result and the size of the
perforation; Pt 0.08, ORt 4.4, ICt 0.83-23.7.
The duration of dry hearing prior to surgery (Table 4) showed
no significant difference in the final result in a patient with
mastoidectomy (≤ 2 months; 3 successful, 1 unsuccessful, >2
months; 18 successful and 5 unsuccessful) P 1.0, OR 0.83, CI 0.10-
10.6, or patients without mastoidectomy (≤ 2 months, 1 successful,
0 unsuccessful,> 2 months, 16 successful and 4 unsuccessful),
comparing both groups, there was no significant difference in the
final result and duration of the study. dry ear prior to surgery Pt 1.0,
OR 1.05, ICt 0.10-10.6.
The cause of tympanic perforation showed no significant
difference in the final result in patients with mastoidectomy
(Traumatic, 1 successful, none unsuccessful, Infectious, 20
successful and 6 unsuccessful) P 1.0, OR 1.3, CI 1.0-1.6, or in
patients without mastoidectomy (Traumatic, 1 successful, none
unsuccessful, Infectious, 16 successful and 4 unsuccessful) P 1.0,
OR 1.25, CI 1.0-1.5, comparing both groups there was no significant
difference in the final result and the cause of perforation tympanic
Pt 1.0, ORt 1.27, ICt 1.09-1.48. Smoking did not show significant
difference in relation to the final result in patients who underwent
mastoidectomy (Yes, none successful, 1 unsuccessful, No, 21
successful, 5 unsuccessful) P 0.22, OR 5.2, IC 2.36-11.4, neither
in patients without mastoidectomy (Yes, 1 successful and none
unsuccessful, No, 16 successful, 4 unsuccessful) P 1.0, OR 1.25, CI
1.0-1.5, comparing both groups there was no significant difference
Pt 0.37, ORt 0.24, ICt 0.01-4.27.
In (Table 5) we compared patients with and without
mastoidectomy in terms of characteristics during surgery and its
association with the final result, observing that there is no significant
difference in the presence of tympanosclerosis and its final result in
patients with mastoidectomy. (Yes, 2 successful and 2 unsuccessful,
No, 19 successful and 4 unsuccessful) P 0.20, OR 0.21, CI 0.02-
1.97, or in patients without mastoidectomy (Yes, 1 successful, and
0 unsuccessful, no; 16 successful and 4 not successful) P 1.0, OR
1.25, CI 1.0-1.5, comparing both groups there was no significant
difference between them either; Pt 0.27, ORt 0.34, ICt 0.04-2.4. The
presence of myenterosclerosis showed no significant difference in
the final result in patients with mastoidectomy (Yes, 9 successful
and 1 unsuccessful, No, 12 successful and 5 unsuccessful) P 0.35,
OR 3.75, CI 0.37-37.9, or in patients without mastoidectomy
(Yes, 8 successful and 3 unsuccessful, No, 19 successful and 1
unsuccessful) P 0.58, OR 0.29, CI 0.25-3.45, comparing both groups
there was no significant difference either; Pt 1.0, ORt 1.21, ICt 0.29-
5.01. The state of the mucosa showed no significant difference in
the final result in patients with mastoidectomy (normal mucosa, 9
successful and 3 unsuccessful, inflammatory mucosa, 12 successful
and 3 unsuccessful) P 1.0, OR 0.75, CI 0.12-4.62, neither in
patients without mastoidectomy (normal mucosa, 16 successful
and 3 unsuccessful, inflammatory mucosa, 1 successful and 1
unsuccessful) P 0.35, OR 5.3, CI 0.25.110, comparing both groups
there was no significant difference either; Pt 0.72, ORt 1.28, ICC
0.30-5.36.
The otorrhea during the surgery showed no significant
difference in the final result in patients with mastoidectomy (Yes, 3
successful, and 1 unsuccessful, No, 18 successful and 5 unsuccessful) P
1.0, OR 0.83, CI 0.07-9.85, nor in patients without mastoidectomy
(Yes, 1 successful, and none unsuccessful, No, 16 successful and
4 unsuccessful) P 1.0, OR 1.25, CI 1.0-1.5, comparing both groups
there was no significant difference either; Pt 1.0, ORt 1.05, ICt 0.10-
10.6. The surgical technique showed no significant difference in the
final result in patients with mastoidectomy (Overlay, 17 successful
and 5 unsuccessful, Underlay, 4 successful and 1 unsuccessful) P
1.0, OR 0.85, CI 0.07.9.44, or in patients without mastoidectomy
(Overlay, 14 successful and 4 unsuccessful, Underlay, 3 successful
and 0 unsuccessful) P 1.0, OR 0.77, CI 0.100-0.99, comparing both
groups did not show significant difference either; Pt 1.0, ORt 0.49,
ICt 0.05-4.54.
Of the 48 patients who had follow-up, 80% were considered
successful (absence of postoperative otorrhea, absence of graft
retraction and complete grafting), 12% presented postoperative
otorrhea, 6% graft perforation and 2% graft retraction of the
48 tympanoplasty in relation to the integration of the graft, we
observed that 94% had the complete graft and 6% perforated
(Graph 2). When separated by group, patients who did not undergo
mastoidectomy had 95% of intact grafts and 4.7% of perforated
grafts (Graph 3) and patients who underwent mastoidectomy had
92.5% of grafts and a 7.4 % of perforated grafts.
Conclusion
In the surgical treatment of OMC, especially in noncholesteatomatous
cases, mastoidectomy is not always a necessary
intervention, being one of the most important justification that
this operation would provide a better drainage of the middle ear
effusion, and open mastoid air cells would increase aeration, which
would facilitate the regression of the disease [5]. In our hospital,
we obtain TAC of temporal bone for all patients with OMC who
will undergo surgery for at least 12 months prior to surgery. We
performed tympanomastoidectomy through a postauricular
approach, however mastoidectomy in patients programmed
especially for tympanoplasty remains controversial. Dündar R, et al
found that in cases of patients without cholesteatoma programmed
for tympanoplasty, the mastoidectomy does not create statistically
significant differences with respect to the success of the graft and
the results of the postoperative hearing [5].
In a systematic review conducted by Eliades and Limb in 2013
on the results of tympanoplasty with and without mastoidectomy
in patients with perforation of the tympanic membrane without
cholesteatoma concluded that the available data do not show
any additional benefit for performing a mastoidectomy with
tympanoplasty for uncomplicated perforations, 7 similar to that
found in our study. case series. In this work, we evaluated patients
with sclerotic mastoid bone detected by CT who had undergone
tympanoplasty with or without mastoidectomy, we did not find any
statistically significant difference between both groups regarding
the success of the surgery.
Of the unsuccessful patients 4 presented postoperative
otorrhea in the group of patients with mastoidectomy and 2
patients in the group without mastoidectomy, we considered that
the follow-up of the study was very short-term, since most of the
otorrhea were treated with medical treatment as throughout its
evolution. When comparing the success of the surgery obtained
only by the integration of the tympanic graft in our study, it resulted
in 95.2% in patients without mastoidectomy and 92.5% in patients
with mastoidectomy, with a global average of 94% in follow-up. 3
months after surgery, against 75-90% reported in the international
literature [12]. In Mexico, a retrospective study conducted by
Solórzano BJV that included 56 patients found a success in the
integration of the tympanic graft of 85.7% [13].
When comparing both groups, the association of the
characteristics prior to surgery, such as perforation size, dry ear
time prior to surgery, cause of perforation and smoking history, we
did not find any statistically significant difference with the result
of the surgery. However, when comparing by group we found that
the size of the tympanic perforation in the group of patients with
mastoidectomy did influence the final result, with worse results
with perforations greater than 50% with a p 0.01. Active otorrhea
at the time of surgery presumably reflects active infection more
recently compared to patients with dry ears, in a systematic review
conducted by Steven J.
Eliades evaluated the role of mastoidectomy performed with
tympanoplasty for tympanic perforation where they were reviewed
26 articles of which 8 compared otorrhea at the time of surgery
vs dry ear, showing worse graft success rates for active disease
in six studies and better in two 7. In that same review, 5 studies
compared the results based in the size of the perforation of the
tympanic membrane, there was a general tendency towards poorer
results, both in the success of the repair and in the hearing with
larger perforations [7].
In a retrospective study conducted by Molina Pichardo H and
García Enríquez B in Mexico, where the objective was to determine
the relationship between drilling tympanic graft after tympanoplasty and
the smoking rate, found that smoking increases the likelihood
of perforation of the tympanic graft after tympanoplasty, with
increased risk when smoking 10 or more cigarettes a day 10. When
comparing both groups, the association of the characteristics during
the surgery as Presence of tympanosclerosis, miringoesclerosis,
state of the middle ear mucosa, otorrhea during the surgery, and
surgical techniques type Overlay and Underlay did not find any
statistically significant difference with the result end of surgery. In
a study conducted by Yurttafl V, et al in 2015 where different factors
that could affect the success of the graft in the tympanoplasty with
mastoidectomy were evaluated, they concluded that the infection
of the middle ear and the morphology of the tympanic membrane
and muco.
Conclusion
In our series of cases, the mastoidectomy shows no additional
benefit in the repair of the tympanic membrane in patients with
chronic non-cholesteatomatous otitis media with sclerotic mastoid
bone, since it does not create statistically significant differences
with respect to graft success. The addition of mastoidectomy to
tympanoplasty may carry unnecessary additional risks and increase
surgical time and costs. Our results show that the characteristics
during and before surgery did not influence the final result when
comparing both groups contrary to what the literature reports.
Within the limitations of our results, they are associated with a
limited number of cases, which influences obtaining results with
greater bias, we also consider making a longer follow-up period can
add value to the present study. With this work we propose to carry
out a study with a larger number of cases and a longer follow-up to
obtain more conclusive results and less bias.
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