Efficacy of mastoidectomy on MRSA-infected chronic otitis media with tympanic membrane perforation

Tympanoplasty With and Without Mastoidectomy for Chronic Otitis Media Without Cholesteatoma: A Systematic Review and Meta-analysis

OBJECTIVE

This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma.

DATABASES REVIEWED

According to PRISMA guidelines, English articles in PubMed, Scopus, CINAHL, and Cochrane Library databases from inception to 7/29/2021 were searched.

METHODS

Studies describing a comparison of patients who underwent T to patients who underwent T&M were included. Studies describing patients with cholesteatoma were excluded. Patient demographics, graft failure rates, and preoperative and postoperative audiological findings were collected. Mean differences (MD) and risk difference (RD) were calculated using RevMan 5.4. Heterogeneity was assessed using Q test and I2 statistic. Risk of bias was assessed using both version 2 of the Cochrane risk-of-bias tool for randomized trials and Risk of Bias in Non-randomized Studies of Interventions.

RESULTS

A total of 27 studies fulfilled eligibility with T (n = 1,711) and T&M (n = 1,186). When pooling the data, mean differences between T versus T&M for air bone gap (-0.3 dB: 95% CI = -1.9 to 1.3, p = 0.730) and pure tone average (1.9 dB: 95% CI = -0.3 to 4.2, p = 0.090) were not statistically significant. Graft failure was higher with T only (16.4% versus 14.2%) than T&M (RD = -0.04, 95% CI = -0.07 to -0.00, p = 0.030, I2 = 35%].

CONCLUSION

This study endorses clinically similar audiological outcomes and a reduced risk difference of graft failure with mastoidectomy. Although these data suggest that adding a mastoidectomy could decrease the risk of graft failure, the risk reduction is minimal. More research on the cost-effectiveness and the specific patient clinical characteristics and comorbidities that would benefit from adding a mastoidectomy is warranted.

Outcome of surgery for chronic suppurative otitis media with resistant Pseudomonas aeruginosa

OBJECTIVE

To assess the effectiveness of surgical treatment of active chronic suppurative otitis media (CSOM) with ciprofloxacin-resistant Pseudomonas aeruginosa (P. aeruginosa) that failed comprehensive local and systemic treatment.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Eleven patients with ciprofloxacin-resistant P. aeruginosa CSOM that remained active despite comprehensive local and systemic treatment. All patients were operated by a single surgeon between February 2016 and July 2019 INTERVENTION(S): Tympanoplasty alone was performed in seven cases and accompanied by mastoidectomy in the other four cases.

MAIN OUTCOME MEASURE(S)

Resolution of infection and tympanic graft take on otoscopy. The secondary outcome measure is hearing.

RESULTS

Tympanic graft take was successful and the infectious process was resolved in 8 out of the 11 cases, yielding a success rate of 73%. The average follow-up was 20 months. No surgical complications occurred.

CONCLUSIONS

Tympanoplasty, with or without mastoidectomy, is safe and yields acceptable anatomical and functional success rates when intensive local and systemic treatment fails to stop the purulent discharge.

Surgical outcomes of simultaneous cochlear implantation with subtotal petrosectomy

OBJECTIVE

To evaluate the surgical outcomes of simultaneous cochlear implantation (CI) with subtotal petrosectomy (SP).

METHODS

Medical records of thirty-one patients (31 ears) who underwent simultaneous CI with SP in two tertiary referral centers for management of profound hearing loss secondary to chronic suppurative otitis media, cholesteatoma, previous open cavity, temporal bone fracture, and temporal bone irradiation were retrospectively analyzed. Pre and postoperative speech performances and related complications requiring surgical correction were evaluated.

RESULTS

Significant improvement in postoperative speech performance was observed in all 31 patients compared to preoperative result. Of the 31 patients, complications occurred in three patients (9.6%). One patient exhibited the breakdown of blind sac closure of the external auditory canal and two others exhibited the migration of the receiver-stimulator cochlear implant. The migrations occurred despite tie-down fixation of the device to the skull. The migrated devices were repositioned using revision surgery.

CONCLUSIONS

Simultaneous CI with SP is an effective and safe surgical method with relatively low complication incidence. However, particular attention should be paid to prevent certain complications. The receiver-stimulator may be predisposed to migrate to abnormal position because it can be placed with lack of tight subperiosteal support at a more superior or posterior location of the skull where the skull curvature changes abruptly than can conventional CI using limited mastoidectomy and posterior tympanotomy approach.

Healing acceleration of mastoidectomy through the external auditory canal incisionless approach

PURPOSE

To evaluate a surgical procedure of canal wall-up mastoidectomy without incision of the canal which enables accelerated healing and enhances hearing outcome.

METHODS

A total of 79 patients were enrolled. A canal-incisionless technique was used in 37 patients undergoing canal wall-up/down mastoidectomy (CWU/DM), explo-mastoidectomy, and cochlea implantation as staged operation after obliteration of the mastoid, and canal incision was used in the remaining 42 patients as comparison group.

RESULTS

Preoperative and postoperative pure tone audiometry/word recognition score and postoperative status including the healing time and complications were analyzed. Healing time of the canal-incisionless procedure (2.7 weeks) was shorter than that of conventional mastoidectomy with canal incision (5.7 weeks). Complication rate of the canal-incisionless procedure was lower than that of canal incision approach, even though statistical meaningless.

CONCLUSION

Despite the small sample size of our study, in patients undergoing CWDM, explo-mastoidectomy, and cochlea implantation, more acceptable healing was achieved using the canal-incisionless technique than with the canal incision technique. CWU/DM without canal incision is useful to achieve optimal surgical view, eliminate pathology of the middle ear, and accelerate healing time.

Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non-cholesteatomatous Chronic Otitis Media: A Comparative Study

OBJECTIVE

To compare the outcome and success of repair of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy.

METHODS

A prospective study where 40 patients with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited during the period of June 2013 to December 2013 from the outpatient clinic of Otorhinolaryngology department, Faculty of medicine, Cairo University. Patients were managed medically and after dryness of their perforations they were operated upon. Twenty patients underwent simple myringoplasty alone and 20 patients underwent myringoplasty with cortical mastoidectomy. Underlay technique with temporalis fascia was done for all patients. Follow-up period was at least 3 months.

RESULTS

Hearing improvement was comparable in both groups. There was no significant difference in graft uptake between the myringoplasty alone group (70%) and cortical mastoidectomy group (80%) (P = 0.7). There was no significant difference in ear dryness between the myringoplasty alone group (75%) and cortical mastoidectomy group (90%) (P = 0.4).

CONCLUSION

Mastoidectomy performed in non-cholesteatomatous CSOM in this study gives no statistically significant benefit over simple myringoplasty as regards graft success rate and dryness of the middle ear with comparable hearing outcome.

Usefulness of cortical mastoidectomy in myringoplasty

OBJECTIVES

The usefulness of cortical mastoidectomy in myringoplasty remains an issue of controversy. We aimed to assess the effectiveness of mastoidectomy on outcomes of tympanoplasty performed in patients with persistent or intermittent discharging chronic suppurative otitis media without cholesteatoma.

STUDY DESIGN

Prospective, randomized, single-blinded study. Level of evidence-1B.

SETTING

Tertiary referral center.

PATIENTS

Three hundred twenty consecutive adult patients presenting persistent or intermittent otorrhea during the preceding 6 months scheduled for myringoplasty were included.

INTERVENTIONS

Patients were randomly assigned to undergo either myringoplasty with cortical mastoidectomy (Group A) or myringoplasty only (Group B).

MAIN OUTCOME MEASURES

Graft success rate and mean postoperative air-bone gap. Auditory outcomes were evaluated at one year postoperatively.

RESULTS

At the end of the follow-up period, there were 24 failures within Group A (success rate, 82.8%) and 34 within Group B (success rate, 76%), statistically not significant. In the univariate analysis, 3 factors were found to be significant in predicting success rate: healthy opposite ear, a long dry period preceding the operation and nonsmoker status. The only factor attaining significance in the multivariate analysis was a dry period longer than 3 months.

CONCLUSION

Cortical mastoidectomy offers no additional benefit in myringoplasty performed on patients with persistent or intermittent discharging CSOM and no evidence of cholesteatoma or mucosal blockage within the antrum.

Subjective and objective outcomes of tympanoplasty surgery at National Hospital Abuja, Nigeria 2005-2009

The objective of this study is to determine the subjective and objective outcomes of tympanoplasty surgery carried out in patients with otitis media and to identify factors responsible for these outcomes. The study setting is tertiary care urban referral hospital in a developing economy and the study methodology is a prospective analysis of patients with diagnosis of chronic suppurative otitis media that had tympanoplasty with or without mastoidectomy between May 2005 and September 2009 at National Hospital Abuja. Subjects were evaluated for age, sex, size and site of perforation, status of operated ear(s) (dry/discharging), status of the contralateral ear, surgical technique, subjective and objective pre-operative and post-operative hearing scores, average post-operative follow-up time, and post-operative complications, and results were statistically analyzed. A total of 45 patients (51 ears) were operated. Age distribution was 8-52 years. Type 1 tympanoplasty was done in 41 patients and Type 3 in 4 patients. Seven of the patient had concomitant mastoid surgery (cortical mastoidectomy). 3/51 of the cases had discharging ears at surgery. 16/45 of the patients (19/51 ears) had cartilage graft tympanoplasty, while 29/45 (32 ears) had temporalis fascia tympanoplasty. 15/16 of the cartilage group as well as 26/29 of the fascia group reported subjective hearing improvement, whilst the actual graft take was 12/16 of the cartilage group and 23/29 of the fascia group. Objective hearing improvement was observed in all of the cartilage as well as 26/29 of the fascia group. This study confirms success of tympanoplasty among Nigerians, and recommends that subjective hearing assessment should form part of indicators for success following tympanoplasty.

Role of methicillin-resistant Staphylococcus aureus in head and neck infections

The prevalence of infection with methicillin-resistant Staphylococcus aureus is increasing. Methicillin-resistant Staphylococcus aureus is also being recognised as an important pathogen in head and neck infections. This review summarises studies published over the past two decades which illustrate the growing prevalence of methicillin-resistant Staphylococcus aureus, and the current therapeutic approaches to head and neck infections caused by this bacterium. These infections include sinusitis, otitis, periorbital cellulitis, cervical lymphadenitis, tonsillitis, thyroiditis, retropharyngeal abscess, and abscesses and wounds of the neck. Treatment of head and neck infections associated with methicillin-resistant Staphylococcus aureus includes drainage and debridement, as well as administration of local and systemic antimicrobials that provide coverage against these organisms and against potential aerobic and anaerobic pathogens that may be present if the infection is polymicrobial.

Clinical effectiveness of ototopical application of mupirocin ointment in methicillin-resistant Staphylococcus aureus otorrhea

OBJECTIVE

Methicillin-resistant Staphylococcus aureus (MRSA) otorrhea has become an increasing problem with regard to infection through the tympanic membrane perforation and postsurgical infection. In particular, dry ear, at the preoperative stage, is considered to be a crucial factor in surgery. We evaluated how to control MRSA otorrhea before and after ear surgery.

PATIENTS AND METHODS

Twenty-six patients having MRSA otorrhea were enrolled in the present study and randomly divided into 2 groups, namely, mupirocin ointment therapy for 16 patients and ofloxacin ear drops for 10 patients. Approximately 0.6 mg of mupirocin ointment was administered locally to the tympanic membrane and the promontory around and through the perforation with its adjacent external ear canal 1 to 4 times for 2 or 3 weeks at the clinic. On the other hand, ofloxacin ear drops were administered daily by the patients for 2 or 3 weeks at home.

RESULTS

Complete elimination of MRSA from the ear was obtained in all patients of the mupirocin group. This showed a significant improvement (p < 0.001) as compared with the ofloxacin group (improvement + cure rate, 40%). Local application of mupirocin did not aggravate hearing acuity of any patients who were evaluated by pure-tone audiometry before and after treatment.

CONCLUSION

The present findings first indicate that minimally essential application of mupirocin ointment is an extremely useful ototopical agent against MRSA otorrhea without ototoxicity.

Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

Objective:

This study aimed to compare outcomes for mastoidotympanoplasty and for tympanoplasty alone in cases of quiescent, tubotympanic, chronic, suppurative otitis media.

Study design:

Single-blinded, randomised, controlled study within a tertiary referral hospital.

Methods:

Sixty-eight cases were randomly allocated into two groups. In group one, 35 ears underwent type one tympanoplasty along with cortical mastoidectomy. In group two, 33 ears underwent type one tympanoplasty alone. Outcome measures were as follows: perforation closure and graft uptake, hearing improvement, disease eradication, and post-operative complications.

Results:

There were no statistically significant differences in hearing improvement, tympanic perforation closure, graft uptake or disease eradication, comparing the two groups at three and six months post-operatively.

Conclusion:

Mastoidotympanoplasty was not found to be superior to tympanoplasty alone over a short term follow-up period. Hence, it may not be necessary to undertake routine mastoid exploration at this stage of disease.