PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 16895781

Revision mastoidectomy.

Joseph B Nadol
View original source ↗Export metadata ↓

Abstract

The first three priorities in surgery for chronic otitis media are (1) the elimination of progressive disease to produce a safe and dry ear, (2) modification of the anatomy of the tympanomastoid compartment to prevent recurrent disease, and (3) reconstruction of the hearing mechanism. The indications for revision following mastoidectomy for chronic otitis media thus involve failure to achieve any of these goals, including recurrent cholesteatoma, recurrent suppuration, recurrent perforation, or recurrent or residual conductive hearing loss. The focus of this article is the management of recurrent cholesteatoma or suppuration; that is, failure to achieve either of the first two priorities.

Explore related subjects

Cholesteatoma, Middle EarChronic DiseaseHumansMastoidOtitis Media, SuppurativeOtologic Surgical ProceduresReoperationTreatment FailureJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Joseph B Nadol. 2006. Revision mastoidectomy.. https://doi.org/10.1016/j.otc.2006.05.003

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

Obliteration of the tympanomastoid cavity: long term results of the Rambo operation.

INTRODUCTION: Radical mastoidectomy and tympanomastoid obliteration with fat tissue, also called the Rambo operation, is proposed to those patients suffering chronic middle-ear disease, with or without cholesteatoma, who have no useful hearing in an ear which cannot be kept dry despite all conservative treatment. METHODS: We analysed retrospectively a series of 46 patients operated upon in our department. Information recorded included the surgical indications, surgical observations, post-operative care and complications. All patients were invited to comment on their long term anatomical and functional results and to express their degree of satisfaction with the procedure. RESULTS: Recurrent infectious episodes were observed in seven cases. Residual cholesteatoma were observed in three cases. After treatment, these patients did not present with further complications. One case presented with multiple episodes of infection with recurrences of cholesteatoma and finally had the obliterated cavity transformed into an open cavity again. For most of the patients, in the long term (i.e. one to 23 years post-operatively (mean eight years)), the operation resulted in a dry ear, ending the need for frequent consultations to clean and disinfect diseased ears or open cavities. CONCLUSION: Obliteration of the tympanomastoid cavity, as proposed by Tom Rambo, shortens considerably the post-operative care period, in comparison with canal wall down mastoidectomy, and is therefore indicated if no serviceable hearing can be expected. In the long term, the rate of complications is low and patients are satisfied.

Cholesteatoma, Middle Ear↗
PubMed2006

Storage of the incus in the mastoid bowl for use as a columella in staged tympanoplasty.

OBJECTIVE: To evaluate whether the incus of the cholesteatomatous ear preserved in the mastoid bowl during the first stage of planned two-stage tympanoplasty can tolerate long-term implantation and be used in ossicular reconstruction during the second stage. METHODS: The study group included 24 ears of 23 patients who underwent staged tympanoplasty for the treatment of middle ear cholesteatoma. At the first stage, after removing the incus to eradicate the middle ear disease, it was returned to the mastoid bowl and stored there until use at the second stage. The average interval between the two stages was 8.3 months (range 6-12 months). RESULTS: The incus was identified in all cases at the second stage: 10 incudes were found to be covered with a thin mucosa layer, 12 were buried in fibrous or granulation tissue, and 2 were joined to the surrounding bone. Residual cholesteatoma was found in six ears, either in the attic (three ears) or tympanic sinus (three ears). It never occurred in the mastoid bowl where the incus had been preserved. In 19 cases, the incus was available as a short columella for ossicular reconstruction. The remaining five cases were reconstructed using a hydroxyapatite ossicle as a long columella, since the stapes superstructure was missing at the second stage. In one case, the stored incus underwent remarkable absorption between stages. CONCLUSION: Preservation of the incus in the mastoid bowl is an effective option in planned two-stage tympanoplasty, when the incus is considered useful for ossicular reconstruction at the second stage.

Cholesteatoma, Middle Ear↗
PubMed2006

Surgical management of retraction pockets of the pars tensa with cartilage and perichondrial grafts.

Stable, self-cleansing retraction pockets of the pars tensa are common incidental findings and require no treatment. In other cases, recurrent discharge occurs and there may also be associated conductive hearing loss. In a minority of cases, cholesteatoma may develop. This paper presents the results of surgery using a graft composed of cartilage and perichondrium for retraction pockets involving the posterior half of the tympanic membrane, as well as early results using a larger graft designed to manage retraction of the entire tympanic membrane. Data on 51 patients with posterior retraction pockets are presented. Forty-two (82 per cent) patients had no aural discharge one year following surgery and the tympanic membrane was not retracted in 43 (84 per cent). The larger 'Mercedes-Benz' graft was used in four patients and the results obtained suggested that it may prove a successful technique for extensive retraction pockets.

Cholesteatoma, Middle Ear↗