Efficacy of Tympanoplasty Without Mastoidectomy for Treating Chronic Otitis Media in Patients With Mastoid Cavity Opacification in Temporal Bone Computed Tomography Findings

Abstract

Objectives: Combined mastoidectomy is generally preferred to tympanoplasty alone when treating patients with chronic otitis media (COM), particularly when temporal bone computed tomography (TBCT) shows that the mastoid cavity contains opacification of soft tissue density. However, in cases with Eustachian tube dysfunction, a mastoid cavity volume may be a burden to its function. We hypothesized that tympanoplasty alone might be better than tympanoplasty combined with mastoidectomy because soft tissue in the mastoid cavity is a sequel to a protective physiological response. Thus, we explored the efficacy of tympanoplasty without mastoidectomy in COM patients exhibiting mastoid air cell opacification on TBCT.

Methods: Between 2010 and 2014, a total of 33 patients, diagnosed with COM and with evidence of mastoid cavity opacification on TBCT, underwent tympanoplasty without mastoidectomy. All ears had been dry for ≥3 months before surgery. All procedures were performed by the same surgeon. We retrospectively analyzed the preoperative otoscopic findings, pre- and postoperative pure tone averages (PTAs; the mean of the values at 0.5, 1, 2, and 4 kHz), surgical procedures, and complications or recurrence.

Results: Of the 33 patients, 28 (84.8%) exhibited hearing improvement after surgery. The mean pre- and postoperative PTAs were 46.9±21.2 dB and 29.4±17.0 dB, respectively (P<0.001). The air-bone gap decreased from 25.7±10.7 dB to 10.3±8.7 dB (P<0.001). Thirty-two patients (97.0%) did not develop any COM recurrence or cholesteatoma; one patient developed attic retraction of the tympanic membrane. Other minor complications were transient otorrhea caused by myringitis (two cases) and a pinpoint perforation (one case).

Conclusion: Tympanoplasty alone, i.e., without mastoidectomy, may adequately control COM, if it shows dry-up status for at least 3 months even though mastoid cavity opacification is detected in TBCT.

Keywords: Computed Tomography; Mastoidectomy; Otitis Media; Temporal Bone; Tympanoplasty.

Fig. 1.

Audiometric evaluation of the successful 28 patients. Both air conduction and the air-bone gap improved significantly.

Fig. 2.

Complications and their management after tympanoplasty. Mastoidectomy was performed on one patient because of progressive attic destruction after surgery. Overall, >80% of patients experienced better hearing outcomes without any complications.

Fig. 3.

No change in opacification was evident on follow-up temporal bone computed tomography of four patients. (A) A 22-year-old female: type I tympanoplasty, left. (B) A 47-year-old male: type III tympanoplasty, left. (C) A 42-year-old female: type III tympanoplasty, left. (D) A 52-year-old female: type I tympanoplasty, right.

Fig. 4.

Resolution of mastoid cavity haziness during post-tympanoplasty follow-up temporal bone computed tomography. (A) A 68- year-old male: type I tympanoplasty, right. (B) A 42-year-old female: type I tympanoplasty, right. (C) A 55-year-old female: type I tympanoplasty, right.