Hearing after surgery in chronically discharging ears. II. Radical operation

Split-thickness skin grafting in postmastoidectomy revision and in lateral temporal bone resection

Objectives

Use of split-thickness skin grafts (STSG) in revision canal wall-down (CWD) mastoidectomy was compared with STSG in lateral temporal bone resection (LTBR).

Study Design and Setting

A retrospective study of 11 patients undergoing revision CWD mastoidectomy and 6 patients undergoing LTBR with STSG in an academic health center setting.

Results

Successful epithelialization of the mastoid cavity occurred in 9 patients (82%) undergoing CWD mastoidectomy. Subjective success, measured as reduction in complaints of otorrhea, occurred in 10 patients (91%). In the 6 patients who underwent LTBR and STSG successful epithelialization of the temporal bone defect occurred in 5 patients (83%).

Conclusions

Successful and rapid epithelialization occurred in the revision mastoidectomy cohort as well as in the primary temporal bone resection cohort.

Significance

Placement of STSG is a useful adjunct in revision CWD mastoidectomy as well as in primary LTBR for cancer.

Split thickness skin grafting in canal wall down tympanomastoidectomy

OBJECTIVE

To characterize the effects of a split thickness skin graft (STSG) on the healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures.

STUDY DESIGN

A prospective randomized study.

SETTING

Tertiary referral center.

PATIENTS

Twenty-four patients, ages 21 to 82 years, with a diagnosis of cholesteatoma, undergoing CWD tympanomastoidectomy for the first time.

INTERVENTION

Placement of a STSG to line the mastoid cavity at the time of surgery.

MAIN OUTCOME MEASURES

The primary outcome was the amount of time required for epithelialization of the mastoid cavity. Secondary outcomes included postoperative complications, specifically, presence of otorrhea, granulation tissue, meatal stenosis, or tympanic membrane perforation.

RESULTS

Twenty-four patients met inclusion criteria. Thirteen patients were randomized to the study group and 11 patients to the control group. Data were collected at follow-up appointments scheduled at postoperative Weeks 3, 6, 9, and 12, as well as every 6 months thereafter. Average time for successful epithelialization of the cavity in the STSG group was 3.2 weeks. Average time for successful epithelialization of the control group was 6.6 weeks. Using a 1-sided 2 sample t test, this was found to be statistically significant with a p value of 0.000137. There was no significant difference in complications rates between the 2 groups.

CONCLUSION

Placement of a STSG is a technique available to the otologist to facilitate rapid healing and epithelialization in patients undergoing CWD tympanomastoidectomy.

Long-term results of the use of cultured autologous epithelial cell grafting to mastoid cavities

Thirty-nine patients (42 ears) who have had a cultured autologous epithelial cell graft technique to a continuously discharging mastoid cavity have been evaluated to determine the continued effectiveness of this procedure. A postal questionnaire indicated a 58% improvement in both the smell and quantity of discharge, and our conclusion is that this is a very effective measure to provide extended symptomatic improvement in this troublesome condition.

Treatment of postoperative otorrhoea by grafting of mastoid cavities with cultured autologous epidermal cells

Autologous cultured keratinocyte layers were grafted onto the unepithelialised open mastoid cavities in 8 patients with otorrhoea for 2 to 32 years. All procedures were done on an outpatient basis without anaesthesia, except for local anaesthesia for skin biopsy. The cultured keratinocyte layers adhered well to the bed of granulation tissue lining the mastoid cavity and formed an excellent protective covering of stratified squamous epithelium. All 8 patients have been free from otorrhoea for the 2 to 6 months since grafting.

Obliteration of mastoid cavities using bone pâté

The authors report on a series of 24 patients in whom open cavity mastoidectomy cavities were obliterated with bone pâté. The aim of the procedure is to provide the patients with a dry ear which then also reduces the need for frequent out-patient attendances.

Long-term results of open cavity and tympanomastoid surgery of the chronic ear

The results of surgery for chronic middle ear infection in 307 patients (347 ears) are reported. All ears were operated on according to one of two procedures: (i) the operative cavity was left open after removal of the posterior canal wall, or (ii) a tympanomastoidectomy with intact canal wall was done. When necessary, removal of disease in the tympanum with or without reconstruction of the sound-conducting mechanism of the middle ear was performed. Cholesteatoma was present in 56% of the ears. Open cavity surgery with no reconstruction was done in 53%. In the remaining 47%, tympanomastoidectomy was performed and in approx. half of these ears reconstruction was undertaken. The postoperative follow-up period averaged 9 years. Residual cholesteatoma was found in 9%. In 4% of the ears undergoing tympanomastoidectomy a retraction pocket cholesteatoma developed. During the follow-up period 13% of the ears required revision surgery. Nineteen per cent of the ear with open cavities were discharging and, in addition, crusts were observed in 13%. In the tympanomastoidectomy group, discharing ears were seen in 26%. As a rule, hearing was not affected by surgery. The mean elevation of the pure tone threshold was 6.5 dB on account of sensorineural loss, while the speech reception threshold shift was 11 dB. The results testify to the importance of removing the posterior canal wall in ears with chronic middle ear infection associated with cholesteatoma.