Long-term Outcomes After Secondary Mastoid Obliteration

作者：Cox Matthew D^*; Dunlap Quinn A; Trinidade Aaron; Dornhoffer John L

来源：Otology & Neurotology, 2016, 37(9): 1358-1365.

DOI：10.1097/MAO.0000000000001187

• Canal wall down
• Cavity
• Mastoid obliteration
• Mastoidectomy
• Ossiculoplasty
• Otorrhea

Objectives:To assess long-term outcomes after secondary mastoid obliteration.Study Design:Case series with chart review.Setting:Tertiary care center.Patients:Adult patients (20-80 yr of age) undergoing secondary mastoid obliteration.Outcome Measures:Hearing results (improvement in pure-tone average air-bone gap [PTA-ABG] from baseline) at the time of postoperative audiometry and at least 5 years after surgery, anatomic outcomes (rate of successful tympanic membrane graft healing), and the incidences of observed complications.Results:An average improvement in PTA-ABG by 16.9dB (p=1.8x10(-9)) was noted. Postoperatively, the PTA-ABG was successfully closed to 20dB in 39.5% (17/43) of patients. The average final PTA-ABG (obtained at least 5 years after surgery) was 25.3dB, which was also a significant improvement over the preoperative baseline PTA-ABG (p <<< 0.01). Significant complications were observed in 14.0% (6/43) of patients, with 9.3% (4/43) requiring a subsequent surgery. Although 69.8% (30/43) of patients experienced otorrhea preoperatively, otorrhea was only observed in 4.7% (2/43) at any point in time postoperatively.Conclusion:Secondary mastoid obliteration with reconstruction of a more natural posterior canal wall, cartilage tympanoplasty, and ossicular chain reconstruction is a hybrid technique that allows for creation of a safe, dry ear with significant, long-term improvement in hearing and functional outcomes in patients with unstable mastoid cavities.

• 出版日期2016-10