Cortical Mastoidectomy Improves the Results of Type I Tympanoplasty: A Myth or Not

Abstract

Introduction: Patients with mucosal variety of COM may have associated disease in the mastoids, which makes it a good practice to explore the mastoids during tympanoplasty. The mastoid pneumatic system is thought to act primarily as a buffer to pressure changes in the middle ear. The presence of pneumatised mastoid greatly increases the volume of the middle ear/ mastoid system, which in accordance with Boyle’s law, can minimize the effect of pressure changes in the middle ear cleft. A poorly pneumatised air cell system lacks this buffering capacity and thus is prone to inflammatory changes in the middle ear cavity.

Objective: To compare the outcomes of patients undergoing Type I Tympanoplasty with and without cortical mastoidectomy.

Materials and Methods: An institution based prospective observational study was conducted in the Department of Otorhinolaryngology in a Tertiary Medical College of Kolkata. The study was conducted from March 2019 to August 2020 which included 120 patients of Mucosal variety of COM attending OPD of Otorhinolaryngology in the Tertiary Institute, after taking proper consent  abiding by the inclusion and exclusion criteria. Patients presented with a history of chronic discharge from the ear (>3 months), without any symptoms and signs of complications.

Result: The comparison of Air Bone gap among the post-operative patients, shows a non-significant value of 0.263 (Independent t test) (>0.05). This shows that there is no significant difference between the outcomes when operated with Type I Tympanoplasty or Type I Tympanoplasty when combined with Cortical Mastoidectomy.

Conclusion: In our study, it has been found out that although the graft uptake rate and the hearing outcomes are better in cases where Tympanoplasty is combined with a Cortical Mastoidectomy, it is not statistically significant. So we can conclude that whether or not combined with a Cortical Mastoidectomy, Type I Tympanoplasty can be used as the treatment of choice in uncomplicated mucosal variety of Chronic Otitis media with mild to moderate degrees of conductive hearing loss.