Literature Review: A Roundup of Important Recent Studies

Bottom line: HACs are uncommon in HNCA surgical patients but are significantly associated with increased in-hospital mortality, morbidity and hospital-related costs.

Citation: Kochhar A, Pronovost PJ, Gourin CG. Hospital-acquired conditions in head and neck cancer surgery. Laryngoscope. 2013;123:1660-1669.

—Reviewed by Amy Eckner

Tympanoplasty Plus Mastoidectomy in Perforations

How effective is the use of mastoidectomy performed with tympanoplasty in bettering outcomes for tympanic membrane perforations?

Background: The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma continues to be debated. According to the authors, well-designed studies to address this issue are lacking in current literature. Arguments for mastoidectomy with tympanoplasty are largely based on theoretical grounds, anecdotal evidence and limited case series.

Study design: Review of 26 peer-reviewed publications on tympanoplasty and mastoidectomy (articles were classified as either randomized controlled trials, prospective cohort, retrospective cohort, retrospective case control or case series).

Setting: MEDLINE search using PubMed to identify English-language articles.

Synopsis: Three primary outcome measures were identified and analyzed: tympanic membrane repair success rate, otorrhea and infection improvement, and hearing outcomes. There was no evidence of improved outcomes following mastoidectomy compared with tympanoplasty alone. No randomized controlled trials supported mastoidectomy for improving outcomes. The majority of the literature came from retrospective reviews comparing outcomes between patients who underwent tympanoplasty with and without mastoidectomy. The retrospective review had a large potential bias based on the criteria with which patients were selected to undergo mastoidectomy.

Collectively, mastoidectomies were generally performed in conjunction with worse disease. Success rates were generally good (>80 percent) for all studies, regardless of whether a mastoidectomy was performed or not. Results were universally favorable for rates of persistent infection and drainage, with >90 percent control in most cases. Rates of persistent otorrhea were similar regardless of whether a mastoidectomy was performed or not. Only two studies showed improved hearing rates for patients undergoing mastoidectomy, and seven showed worse hearing rates. Results suggest worse overall outcomes for patients with prominent mucosal inflammatory disease, but no definitive benefit from undergoing mastoidectomy was demonstrated. MRSA patients might benefit from mastoidectomy with a tympanoplasty to eradicate hidden infection reservoirs.

Bottom line: The available literature shows no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated tympanic membrane perforations. There is not enough evidence to make recommendations for those with more complicated perforations.

Citation: Eliades SJ, Limb CJ. The role of mastoidectomy in outcomes following tympanic membrane repair: a review. Laryngoscope. 2013;123:1787-1802.