Best Practice in Tympanoplasty

Does concomitant mastoidectomy improve outcomes for patients undergoing repair of tympanic membrane perforations?

Background: Controversy currently exists regarding the appropriate treatment of tympanic membrane perforations resulting from chronic suppurative otitis media (CSOM) without cholesteatoma. Proponents for mastoidectomy contend that surgical opening of the mastoid pneumatic system buffers pressure changes in the middle ear and allows for the debridement of infected tissue and devitalized bone that may not otherwise be treated effectively. Recent studies, however, refute the claim that mastoidectomy improves outcomes.

Study design: Literature review.

Setting: Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn.

Synopsis: The authors described four retrospective case-controlled studies with internal controls and one retrospective cohort study, all for the treatment of noncholesteatomatous CSOM. In a study with 320 patients undergoing tympanoplasty alone and 144 with mastoidectomy, the rate of perforation repair was not statistically significant between the two groups but there were clinically significant trends toward improved hearing and decreased need for subsequent procedures. In a study with 323 patients with CSOM, the authors concluded that mastoidectomy is an avoidable procedure. Another study with 251 patients ended with the researchers concluding that mastoidectomy is not helpful for patients with noncholesteatomatous CSOM. A study with 47 children showed that approximately 40 percent required at least one subsequent operation. And, with an analysis of 46 patients undergoing tympanoplasty alone and 46 undergoing tympanomastoidectomy, the authors concluded that mastoidectomy may not be necessary.

Bottom line: As evidenced in the literature, tympanoplasty alone may be sufficient for repair of simple and uncomplicated tympanic membrane perforations.

Citation: Hall JE, McRackan TR, Labadie RF. Does concomitant mastoidectomy improve outcomes for patients undergoing repair of tympanic membrane perforations? Laryngoscope. 2011;121(8):1598-1600.

-Reviewed by Sue Pondrom