Cavity problems following canal wall down mastoidectomy in chronic suppurative otitis media: Are we treating adequately or making them regular outpatients?

Abstract

Aim: To identify and address the postoperative cavity problems following canal wall down mastoidectomy (CWDM) early in chronic suppurative otitis media (CSOM) to minimize the persistent otological problems was the aim of the study. Materials and methods: This was a prospective, observational study to describe the postoperative cavity problems following CWDM in CSOM patients. Results: Of 50 patients, men (54%) outnumbered women. The patients were aged between 6.5 years and 50 years with a mean ± standard deviation of 21.19 ± 10.58 years. Unilateral involvement was frequent (82%). Otorrhea (100%), hearing loss (86%), and perforation of tympanic membrane (84%) were the major findings. The mean duration of otorrhea and hearing loss were 7.57 years (5 days–30 months) and 1.33 years (2 days–7 years), respectively. Bilateral sclerosis (70%) was a remarkable radiological finding. Complications were categorized as extracranial (16%) and intracranial (20%). Intracranial complications included meningitis (03), subdural empyema (02), cerebellar abscess (02), temporal lobe abscess (02), and cerebritis (01). Mastoid abscess (07) and facial nerve palsy (01) were the extracranial complications. Intraoperative complications included cholesteatoma and destruction of incus; The common location of cholesteatoma was the epitympanum (62%) followed by a mastoid bowl (26%). Destruction of the incus either part or as a whole was noted in all. Superficial infection of the cavity, transient discharge, and granulations were the common postoperative complications. Facial nerve involvement after surgery was seen in three. Ninety-eight percent of the postoperative cavities were epithelialized by 6 months. Recurrent discharges from cavity, granulations, and debris were the persistent complications. Conclusion: We reemphasize the need for meticulous surgery (adequately lowered facial ridge, circumferential saucerization, and wide meatoplasty), as multiple factors are responsible for postsurgical cavity problems.