Cavity problems after mastoid surgery and it’s management-various aspects-
Tympanoplasty and Mastoidectomy (Tympanomastoidectomy) “Cavity issues” occurring after mastoid surgery, commonly known as a “persistent mastoid cavity,” may present as chronic ear discharge (otorrhea), growth of granulation tissue inside the cavity, accumulation of wax, and challenges in fitting hearing aids, and can arise from insufficient removal of infected tissue during the operation or poor post-operative care; treatment generally includes regular cleaning of the ear, use of topical medications, and in more severe instances, additional surgical procedures to close the cavity or correct particular anatomical problems leading to the issue.
If any patient of ENT requires any surgery, opd consultation or online consultation in clinic of ENT specialist Doctor Dr Sagar Rajkuwar ,he may contact him at the following address-
Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik ,422010 ,Maharashtra, India-Dr Sagar Rajkuwar (MS-ENT), Cel no- 7387590194 , 9892596635
Inadequate surgical technique:
Not entirely excising diseased tissue or creating a cavity that is incorrectly shaped with insufficient drainage can result in ongoing discharge.
High facial ridge:
A pronounced bony ridge located near the ear canal entrance can block drainage from the mastoid cavity.
Stenotic external auditory canal:
A constricted ear canal can complicate the cleaning of the cavity and hinder proper drainage.
Poor epithelialization:
The skin lining’s inability to adequately grow over the cavity walls can result in discharge.
Residual cholesteatoma:
Should a cholesteatoma (a skin growth) not be fully removed during the surgical procedure, it may recur and cause discharge.
Granulation tissue:
An excessive formation of new tissue within the cavity can impede healing and lead to discharge.
Mastoid tip cell involvement:
If the mastoid tip cells are not sufficiently managed during surgery, they can become a source of infection and discharge.
Improper cavity design:
An excessively large or ill-shaped cavity can be more likely to collect debris and discharge.
Important points to consider:
Severity of initial condition:
Patients experiencing more severe ear infections or having complex anatomical structures may face a greater risk of post-surgical cavity complications.
Surgical approach:
Certain surgical methods, such as canal wall down mastoidectomy, might present a higher risk of cavity complications compared to other techniques.
Management of cavity problems:
Regular cleaning and topical medications:
Cleaning the cavity using ear drops or irrigation to eliminate debris and manage infection.
Revision surgery:
In severe instances, a follow-up surgery might be necessary to correct issues like a high facial ridge, poor cavity design, or remaining disease.
Mastoid obliteration:
In specific situations, the surgeon might opt to obliterate the cavity with bone grafts or other materials to minimize the likelihood of future complications.
Key symptoms of cavity problems after mastoid surgery: Symptoms of issues related to cavities after mastoid surgery include ear discharge, hearing loss, dizziness, and tinnitus.
Symptoms
Ear discharge: A frequent symptom that may be ongoing or sporadic
Hearing loss: Components in and around the ear can deteriorate, leading to hearing loss
Dizziness: May indicate issues with cavities following mastoid surgery
Tinnitus: A sound perceived in the ear, like buzzing, hissing, or ringing
Mastoid tenderness: May indicate issues with cavities following mastoid surgery
Granulations: May indicate issues with cavities following mastoid surgery
Wax: May indicate issues with cavities following mastoid surgery
Keratin accumulation: May indicate issues with cavities following mastoid surgery
Risk factors include older age (≥50 years), insufficient postoperative care, and diabetes.
When to seek medical care
You should reach out to your healthcare provider if you experience: A fever of 100. 5 degrees Fahrenheit (38. 05 degrees Celsius) or higher, significant ear bleeding or discharge, facial weakness, dizziness or vertigo, and hearing loss.
Key points regarding cavity issues after mastoid surgery and their management:
To address cavity issues following mastoid surgery, the main choice is mastoid cavity obliteration, which involves filling the surgical cavity with materials such as bone grafts or tissue to seal it, reducing the chances of discharge, infections, and frequent cleanings; this is commonly performed alongside a procedure known as meatoplasty, which expands the ear canal opening for improved drainage and easier cleaning access.
Causes of cavity issues:
A large mastoid cavity remaining after surgery may result in recurring infections, discharge, discomfort, and hearing problems due to the accumulation of debris.
Mastoid obliteration procedure:
This requires filling the cavity with appropriate materials like autologous bone graft, fat, or synthetic substances depending on the situation.
Benefits of obliteration:
Decreases the risk of chronic discharge
Minimizes the need for regular ear cleaning
Enhances hearing results in some instances
May lower the chance of vertigo caused by exposure to cold water
Alternative treatment methods for cavity management:
Regular cleaning and irrigation: If obliteration is not carried out, the patient might need to consistently clean the cavity using ear drops and suctioning to control discharge.
Antibiotics: In cases of infection, topical or oral antibiotics could be prescribed.
Revision surgery: If the initial surgery results in a problematic cavity, a revision operation may be necessary to resolve the concern.
Important considerations:
Consult your ENT specialist:
Always review the optimal treatment approaches for your individual case with your ear, nose, and throat practitioner.
Follow-up care:
Consistent post-operative visits are essential to track the healing progress and handle any complications.
Lifestyle modifications:
Avoid exposing your ear to water, blowing your nose vigorously, and participating in intense activities as advised by your physician.
Common cavity problems
Discharge: Ongoing discharge from the mastoid cavity is a frequent issue following surgery.
Granulations: Granulations may develop within the cavity.
Wax buildup: Wax can build up in the cavity.
Structural problems: Inadequate meatoplasty or insufficient lowering of the facial ridge may necessitate additional surgery.
When to call a doctor
You have a fever of 100. 5°F (38. 05°C) or above
You experience heavy ear bleeding or discharge
You have facial weakness
You feel dizziness or vertigo
You experience hearing loss
Methods
Patients who had experienced canal wall-down mastoidectomy for chronic otitis media with the formation of a persistent mastoid cavity and had revision tympanomastoid surgery that included mastoid cavity obliteration using autologous material were part of the study. Audiological assessments including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) as well as the air–bone gap (ABG) were evaluated. Health-related Quality of Life (HRQoL) was measured by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) both before and after the surgery.
Results
In total, 25 patients (16 females and 9 males; average age 51. 6 years, with 14 right and 11 left ears) were examined. Patients were reassessed after an average follow-up duration of 9. 2 months (SD = 6. 5) following the obliteration of the mastoid cavity. When compared to the initial visit, patients exhibited a significantly lower AC PTA at the postoperative visit
Conclusions
This is the initial study documenting a highly significant and clinically crucial enhancement in HRQoL following mastoid cavity obliteration in a prospective context. The improvement in HRQoL was found to be unrelated to the hearing improvement. As a clinical implication, we present evidence of a considerable subjective benefit from the surgical obliteration of a problematic mastoid cavity and, consequently, we advocate for this surgical approach.
