Citation Information :
Bhat SM, Vuppala R. Cavity Problems Following Canal Wall Down Mastoidectomy in Chronic Suppurative Otitis Media: Are We Treating Adequately or Making Them Regular Outpatients?. Int J Otorhinolaryngol Clin 2021; 13 (1):11-17.
Aim: To identify and address the postoperative cavity problems following canal wall down mastoidectomy (CWDM) early in chronic suppurative otitis media (CSOM) to minimize the persistent otological problems was the aim of the study.
Materials and methods: This was a prospective, observational study to describe the postoperative cavity problems following CWDM in CSOM patients.
Results: Of 50 patients, men (54%) outnumbered women. The patients were aged between 6.5 years and 50 years with a mean ± standard deviation of 21.19 ± 10.58 years. Unilateral involvement was frequent (82%). Otorrhea (100%), hearing loss (86%), and perforation of tympanic membrane (84%) were the major findings. The mean duration of otorrhea and hearing loss were 7.57 years (5 days–30 months) and 1.33 years (2 days–7 years), respectively. Bilateral sclerosis (70%) was a remarkable radiological finding. Complications were categorized as extracranial (16%) and intracranial (20%). Intracranial complications included meningitis (03), subdural empyema (02), cerebellar abscess (02), temporal lobe abscess (02), and cerebritis (01). Mastoid abscess (07) and facial nerve palsy (01) were the extracranial complications. Intraoperative complications included cholesteatoma and destruction of incus; The common location of cholesteatoma was the epitympanum (62%) followed by a mastoid bowl (26%). Destruction of the incus either part or as a whole was noted in all. Superficial infection of the cavity, transient discharge, and granulations were the common postoperative complications. Facial nerve involvement after surgery was seen in three. Ninety-eight percent of the postoperative cavities were epithelialized by 6 months. Recurrent discharges from cavity, granulations, and debris were the persistent complications.
Conclusion: We reemphasize the need for meticulous surgery (adequately lowered facial ridge, circumferential saucerization, and wide meatoplasty), as multiple factors are responsible for postsurgical cavity problems.
Bozan N, Duzenli U, Kundi P, et al. Meatal obstruction following canal wall down mastoidectomy. J Pak Med Assoc 2017;67(9):1450–1451. PMID: 28924294.
Roden D, Honrubia VF, Wiet R. Outcome of residual cholesteatoma and hearing in mastoid surgery. J Otolaryngol 1996;25(3):178–181. PMID: 8783083.
Paudel DR. Chronic suppurative otitis media atticoantral-type undergone canal wall down mastoidectomy in a peripheral government hospital of Nepal. JNMA J Nepal Med Assoc 2013;52(192):596–599. PMID: 25327234.
Rao SM, Chandra PR. A comparative study of canal wall up and canal wall down procedures in the management of atticoantral disease. J Evid Based Med Healthc 2017;4(88):5155–5158. DOI: 10.18410/jebmh/2017/1029.
Palva T, Hallstrom O. Bacteriology of chronic otitis media. Arch Otolaryng 1992;82(4):359–364. DOI: 10.1001/archotol.1965.00760010361005.
Wormald PJ, Nilssen EL. Do the complications of mastoid surgery differ from those of the disease? Clin Otolaryngol Allied Sci. 1997 Aug;22(4):355–357. DOI: 10.1046/j.1365-2273.1997.00026.x.
Gyo K, Hirata Y, Yanagihara N. Changes in bacterial flora in the tympanic cavity following tympanoplasty Otorhino Clinic 1994;86:579–582. J-GLOBAL ID:201002118130100612 Reference number:10A1432883
Bowdler DA, Walsh RM. The use of Davis pinch grafts to promote epithelialization in a post- mastoidectomy cavity. Rev Laryngol Otol Rhinol (Bord) 1995;116(1):65–68. PMID: 7644851.
Asma A, Shaharudin MH, MuhdAlmyzan A, et al. Outcome of canal wall down mastoidectomy: experience in sixty three cases. Med J Malaysia 2013;68(3):217–221. PMID: 23749009.
Wahid FI, Khan A, Khan IA. Complications of chronic suppurative otitis media: challenge for a developing country. Kulak Burun Bogaz Ihtis Derg 2014;24(5):265–270. DOI: 10.5606/kbbihtisas.2014.14477.
Kabdwal N, Varshney S, Bist SS, et al. Pre and post operative evaluation of hearing in chronic suppurative otitis media. Indian J Otol 2013;19(4):164–168. DOI: 10.4103/0971-7749.124505.
Kulkarni RD, Dharmadhikari CA., Kulkarni VA., et al. Bacteriological study of Chronic Otitis media, Indian Journal of Otolaryngology and Head and Neck Surgery 1993:2(2);110–112.
Chandrashekharayya SH, Kavitha MM, Handi P, et al. The management of otogenic lateral sinus thrombosis – a 6 year experience at a tertiary care hospital in north karnataka, INDIA. J Clin Diagn Res 2012;6(7):1272–1275. Available from: http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1272-1275&id=2476. ID: JCDR/2012/4783:2476
Vidhya M. A dissertation on comparison of the results of outcome of canal wall up mastoidectomy and canal wall down mastoidectomy for chronic suppurative otitis media. Available from: http://repository-tnmgrmu.ac.in/id/eprint/1234 [Accessed on November 22, 2017].
Irwan AG. Epidemiology, preoperative evaluations and surgical findings in CSOM. Available from: http://eprints.unsri.ac.id/857/1/Epidemiology_n_surgical_finding_CSOM.pdf [Accessed on November 22, 2017].
Edelstein PR, Parisier SC, Ahuja GS, et al. Cholesteatoma in the pediatric age group. Ann Otol Rhino Laryngol 1988;97(1):23–29. DOI: 10.1177/000348948809700105.
Jamro BU, Magsi PB, Sangi HA. Intraoperative findings during canal wall down mastoidectomy in chronic suppurative otitis media (CSOM) at Tertiary Care Hospital Sukkur, Pakistan. RMJ 2013;38(2):173–176.
Kurien M, Job A, Mathew J, et al. Otogenic intracranial abscess: concurrent craniotomy and mastoidectomy--changing trends in a developing country. Arch Otolaryngol Head Neck Surg 1998;124(12):1353–1356. DOI: 10.1001/archotol.124.12.1353.
Castrillion R, Kos I, Montandon P, et al. Long-term results of canal wall down mastoidectomy: Schweiz Med Wochenschr 2000;125(Suppl.):58S–65S. PMID: 11141942.
Khan AA, Manzoor T, Shah AA, et al. Evaluation of mastoid cavities after canal wall down mastoidectomy. PAFMJ 2009;59. Available from: http://www.pafmj.org/showdetails.php?id=263&t=o [Accessed on November 22, 2017].
Vartiainen E. Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma: AurisNasus Larynx 200l;27(3):227–229. DOI: 10.1016/s0385-8146(99)00071-1.
Paparella MM, Kim CS. Mastoidectomy update. Laryngoscope 1977;87(12):1977–1988. DOI: 10.1288/00005537-197712000-00001.