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Cartilage, either from the concha, tragus or nasal septum, muscle flaps, bone pâté or fascia are used. Usually, the use of autologous material is preferred due to its good biocompatibility.
![mastoid obliteration mastoid obliteration](https://i.ytimg.com/vi/4oTK1cYl8WQ/maxresdefault.jpg)
Multiple methods and materials for cavity obliteration, which is commonly performed in combination with meatoplasty, have been developed and tested. In these cases, the treatment of choice consists of the secondary surgical obliteration of the mastoid cavity as first described by Mosher in 1911.
![mastoid obliteration mastoid obliteration](https://image.slidesharecdn.com/adityacwuppt-150901191754-lva1-app6892/95/canal-wall-up-mastoidectomy-intact-bridge-mastoidectomy-by-draditya-tiwari-40-638.jpg)
Depending on the extent of the mastoid cavity and the size of the external auditory canal, the self-cleaning process of the mastoid cavity may be disturbed, leading to recurrent infections, secretion, vertigo, hearing impairment, and frequent consultation of an ENT specialist. Nowadays, the primary creation of a mastoid cavity is performed as part of a canal wall-down mastoidectomy in cases of large cholesteatoma or inflammatory processes inside the mastoid. Historically, in extended inflammation processes of the middle ear and mastoid, an open mastoid cavity was created without reconstruction under the aim of draining the disease into the bony outer ear canal. As a clinical implication, we provide evidence for a substantial subjective benefit of the surgical obliteration of a symptomatic mastoid cavity and, therefore, encourage this surgical procedure. The improvement in HRQoL was not correlated to the hearing improvement. This is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. The mean ZCMEI-21 score changes were neither correlated to the AC PTA shift ( p = 0.60) nor to the ABG shift ( p = 0.66). Compared to the preoperative visit, patients showed a significantly reduced AC PTA at the postoperative visit (mean difference: − 4.1 SD = 10.4, p = 0.045). Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. ResultsĪ total of 25 patients (16 females and 9 males mean age 51.6 years, 14 right and 11 left ears) were included. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air–bone gap (ABG) were assessed. Patients who had undergone canal wall-down mastoidectomy for chronic otitis media with creation of a persistent mastoid cavity and underwent revision tympanomastoid surgery including mastoid cavity obliteration using autologous material were included. © 2020, Otology & Neurotology, Inc.To assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration. It might help to reduce morbidity by improving the surgeon's control over mastoid bowl size and shape.
![mastoid obliteration mastoid obliteration](https://i.ytimg.com/vi/38ZWlHMgeWw/maxresdefault.jpg)
The described technique used for mastoid obliteration using autologous bone dust and cartilage is simple, effective, and safe to reduce the size of the mastoid cavity in patients undergoing CWD mastoidectomy. Clinical, radiographic, and surgical appearance of grafted bone dust suggests good take with long-term viability. Postoperative otorrhea, while rare, was managed successfully with topical medication in all affected patients. Results:Īt mean follow-up of 29 months, 95% of ears have remained dry and safe since mastoid obliteration, with a lack of symptoms and no evidence of recurrent disease. Postoperative infection, need for mastoid bowl cleaning, incidence of recurrent cholesteatoma, need for revision surgical intervention. Temporalis fascia and/or an inferiorly-based periosteal flap were used for coverage of the bone dust. Bone dust harvested from healthy mastoid cortex was used to obliterate selected portions of the tympanomastoid defect. Intervention:Īll patients underwent CWD mastoidectomy and, if indicated, concurrent tympanoplasty and ossicular chain reconstruction. Study Design:įorty-three consecutive CWD procedures using bone dust obliteration for chronic otitis media. To describe a technique for mastoid obliteration following canal wall down (CWD) mastoidectomy for chronic otitis media with cholesteatoma, and review its early results in producing a dry, safe ear, and a small mastoid cavity.
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