CAVITY PROBLEMS AND THEIR MANAGEMENT IN POST MODIFIED RADICAL MASTOIDECTOMY IN PEDIATRIC POPULATION - A CLINICAL AUDIT

Objective: To find out the intensity and frequency of cavity problems of persistent and recurrent ear discharge in young children and their management in post Modified Radical Mastoidectomy (MRM). Study Design: Cross sectional study. Place and Duration of Study: Department of ENT Head & Neck Surgery, Lady Reading Hospital MTI Peshawar Pakistan, from Jan 2015 to Dec 2019. Methodology: Fifty-four patients with cavity problems of persistent and recurrent ear discharge needing treatment were included in the study (out of the total patients 234 operated upon). Patients were followed up for one year for any discharge of the mastoid cavity. Patients of both gender of age 15 years or younger were included in the study. Results: In this study the cavity problems were found in 23.1% (54 out of 234) of the post modified radical mastoidectomy in pediatric population. There were no surgery related problems in 61.1% patients. In 38.9% (21 out of 54) percent patients repeat mastoidectomy was performed. Where as in 37% (20 out of 54) excision of granulation and conservative management was sufficient in curing the disease. High facial ridge was found to be the most common cause of persistent/recurrent discharge 9 out of 54 (16.7%). The independent variables (Indications for repeat mastoidectomy, Factors causing discharge, Surgery related problems) support the dependent variable treatment outcome. The sig/p-value was zero therefore the result was significant. Conclusion: In post Modified Radical Mastoidectomy, the cavity can be dry provided meticulous care is given to complete exenteration of disease from all areas........

Primary middle ear inverted papilloma – a case report

Inverted papilloma is a very rare finding in the middle ear. It is a benign, though locally aggressive tumour with a tendency towards malignant transformation. The dia­gnosis is usually established postoperatively, based on the histological examination, because the local finding is not specific and resembles chronically inflamed tissue in chronic otitis media. Surgery is the treatment of choice. Radiotherapy is reserved for inoperable tumours or a recurrent disease. In this case report, we present a case of a 62-year-old man, who underwent canal wall down tympanoplasty for chronic otitis media in a district hospital many years ago. A few years ago he was examined for pulsatile tinnitus and hearing impairment at our clinic. A combined-approach tympanoplasty did not reveal the expected tumour (only stiff scars) and a clearance of the middle ear cavity was performed. Histological examination revealed an inverted papilloma. A CT scan performed postoperatively proved a tumour persistence. Therefore, a radical mastoidectomy was indicated. The patient is disease-free with no signs of recurrence during 32-month follow-up. Keywords: inverted papilloma – Middle ear – radical mastoidectomy

Cholesteatoma extending into the sternocleidomastoid muscle presenting as a Bezold abscess

Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.

Mastoid cavity obliteration with bone dust: a retrospective study of 34 cases

<p><strong>Background: </strong>Chronic suppurative otitis media leads to ear discharge with hearing loss with squamosal type often presents with cholesteatoma and mainstay of treatment is surgical. Modified radical mastoidectomy is the ideal surgical option in these cases but it results in open mastoid cavity formation with certain common cavity problems. This study done to find the results of mastoid cavity obliteration with autologous bone dust and how this technique is effective in avoiding long term cavity problems and assists in ossiculoplasty.</p><p><strong>Methods: </strong>This is a retrospective observational study done in a tertiary care hospital. Patients presented with squamosal type of chronic otitis media were operated for a canal wall down modified radical mastoidectomy.The mastoid cavity was obliterated using bone dust. A follow up of the patients was done and the healing of the cavity with the hearing result assessed.</p><p><strong>Results: </strong>The study includes total of 34 patients. 58.82% were male and 41.18% were female. All patients underwent canal wall down modified radical mastoidectomy and obliteration of the mastoid cavity was done with bone dust. The common cavity problems of discharge, debris were markedly reduced in an obliterated cavity with better healing of the cavity. The middle ear aeration was maintained assisting the ossicular reconstruction.</p><p><strong>Conclusions: </strong>This study showed that mastoid cavity obliteration with bone dust offers significant long term benefits in providing dry, well epithelized cavity at the same time assisting in ossicular reconstruction.</p>

A case study of post-auricular persistent mastoid cutaneous fistula closure by anteriorly based temporalis muscle flap and tempero-mastoid fascio-cutaneous-periosteal flap

<p class="abstract">Post-auricular cutaneous mastoid fistula (PAMCF) is a rare complication of chronic otitis media (COM), following complicate mastoid surgery and very rarely following congenital cholesteatoma. The failure rate with simple closure is high due to necrotic skin edges. Therefore several techniques for the closure of this fistula have been described. Post aural fistula after canal wall down (CWD) mastoidectomy can be successfully treated by fistula tract excision and obliterating the mastoid cavity. A 45 year old woman presented with discharging PAMCF, 10 years following radical mastoidectomy surgery. It was due to non-compliance of the patient, as she had not gone for follow up for 10 year following radical mastoidectomy. The temporo-mastoid fascio-cutaneous-periosteal advancement flap is effective for proper closure of the fistula and obliteration of the cavity by conchal cartilage along with anteriorly based vascularised pedicled temporalis muscle flap to ensure the viability of the flap and preventing the necrosis of the skin edges, henceforth the recurrence of the fistula.</p>

Double Trouble of Double Fistulae

The complications of attico-antral type of Chronic Suppurative Otitis Media (CSOM) are severe due to underlying bone erosion. We describe a case of a 40-year-old lady with attico-antral CSOM and mastoiditis with a postauricular fistula, who underwent modified radical mastoidectomy with excision of the postauricular cutaneous mastoid fistula. Interestingly, another fistula over the dome of lateral semicircular canal was noted intraoperatively.Few reports of occurrence of postauricular mastoid fistula with a labyrinthine fistula have been documented.