COMPARISON OF POST-AURICULAR SOFT TISSUE AND POSTAURICULAR SOFT TISSUE WITH AUTOLOGOUS BONE PATE IN OBLITERATION OF CANAL WALL DOWN MASTOIDECTOMY CAVITY

Abstract

Background A canal wall-down mastoid cavity constitutes a major morbidity to patients with chronic ear disease. The consequences include susceptibility to infection with exposure to water, recurrent otorrhea, need for frequent cleaning, difficulty with the use of conventional hearing aids and vertigo caused by warm or cold air or water exposure leading to a poor postsurgical outcome. The surgical management of Chronic otitis media with cholesteatoma (COMC) can be classified into two main techniques viz. Canal Wall Down Mastoidectomy (CWDM) and Canal Wall Up Mastoidectomy (CWUM), each one having advantages and disadvantages. The major objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, prevention of recurrent disease, and maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal Wall Down Mastoidectomy (CWDM) has been traditionally used to achieve those goals with greater or lesser degrees of success. It has several advantages such as excellent exposure and easy access to the mesotympanum and epitympanum, which allows the eradication of disease and post-operative observation. Obliteration of the mastoid cavity is additionally important procedure performed at the end of CWDM surgery to minimize the size of the mastoid cavity and providing ventilation and easy access for post-operative cleaning of the mastoid cavity. Several methods of reducing cavity volume have been described during CWDM surgery, including amputation of the mastoid tip, saucerization and mastoid obliteration. Among these methods, mastoid obliteration includes use of two different types of material, one is biological (autologous grafts, allografts, and xenografts) and the other, synthetic. xiv Biological materials are the best option for mastoid obliteration and reconstruction of the posterior ear canal. Soft tissue flaps and autologous bone pate have also been used successfully to obliterate the mastoid cavity in CWDM surgeries for over two decades. Soft tissue flaps include various flaps such as fascia graft, palva or inferior based flap, and although each flaps has its advantages, some studies have used the palva flap mainly because of its ease of use and simplicity of its design. In addition, the palva flap has sufficient blood flow from the broad pedicle and nerve supply from the post auricular nerve branch of the facial nerve, which does not cause postoperative flap atrophy. In this study, we intend to evaluate the effectiveness of mastoid obliteration using autologous bone pate or postauricular fibro periosteal soft tissue in patients who underwent CWD mastoidectomy. Objectives The purpose of this study was to evaluate the effectiveness of mastoid obliteration with postauricular soft tissue and post-auricular soft tissue with autologous bone pate in obliteration of canal wall down mastoidectomy cavity mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma, mainly for infection control and drainage, recurrence of cholesteatoma and water tolerance. Methods This prospective interventional study was carried out at R.L Jalappa hospital, Kolar, Karntaka. Sixty-two patients afflicted with chronic otitis media–squamous disease were included in the study. The patients were then planned for a canal wall down mastoidectomy with tympanoplasty with obliteration of the mastoidectomy with meatoplasty. The patients xv were divided into two groups: group ‘A’―who underwent obliteration by post auricular soft tissue and group B―who underwent obliteration by palva’s flap (postauricular soft tissue with bone pate). Following the surgery, the patients were evaluated at 30th, 60th, 90th and 180th day post-operatively for cavity problems. Results We found that in our study the rate of incidence of cavity problems remains almost similar in either group. The majority of the patients had a right sided disease. Majority of the patients afflicted by the disease seemed to be between 41-60 years of age. Five patients out of 62, developed cavity problems―three in group A and two in group B. The cavity problems noted were: vertigo (1/5); surgical site infection (2/5), graft failure (2/5). However, there were no statistically significant differences (p-value: 0.66) between either of the obliteration methods in terms of mitigating cavity problems. Conclusion Both the methods of obliterating the mastoidectomy cavity―post-auricular soft tissue and post-auricular soft tissue with autologous bone pate in obliteration of canal wall down mastoidectomy cavity provided similar results in terms of mitigating cavity problems.