Evaluation of Tympano-Mastoid Surgery for Controlling Infection in active Chronic Suppurative Otitis Media with Cholesteatoma/ A Follow-up Study


  • Qaysar Abdulwahhab Suker MBChB, FACMS in Otolaryngology, Thiqar Health Department
  • Majid Jalil Radhi MBChB, FICMS, FACMS in Otolaryngology,Thiqar Health Department
  • Yasien Abdritha Ajbara MBChB, HDMAST, Clinical Audiologist & Speech Therapist, Thiqar Health Department


Background: Control of infection in chronic suppurative otitis media can be achieved by performing surgical techniques as well as medical treatment can be beneficial. Persistent otorrhoea and/or occasionally hearing impairment can be relatively reduced by surgical technique. Although several surgical techniques exist for the treatment of chronic suppurative otitis media, the procedure is selected based on the audiological finding, surgeon experience, and extent of disease. Patients & Methods: A prospective study was performed within eight months. Thirty-four patients included (24 males &10 females); age range was (9-40 years), with chronic suppurative otitis media attended Otolaryngology Department for surgery. A thorough history and examination, audiological, laboratory & radiological investigations were recorded & analyzed. Ear drops and antibiotics were given to all patients before and after surgery. All included patients underwent tympano-mastoidectomy; 11 cases (5 males and 6 females) by intact canal wall technique & 23 cases (19 males and 4 females) by canal wall down technique with follow up 8 months& data recorded& analyzed.    Results:  -Through a period of 8 months all patients were followed up in scheduled visits at 1st week, 1st month, 3rd months, 6th months & 8th month postoperatively. -The overall satisfactory control was achieved in 23patients (67.6%) who have dry ears, while 11patients (32.4%) remained with wet ears. -Out of 23 patients with dry ears, 19(55.8%) patients have cholesteatoma & 4(11.8%) patients have active mucosal disease. -The canal wall down (modified radical) technique was performed in 23 patients & resulted in 18(78.3%) patients having dry ears (15patients have cholesteatoma &3patients had the active mucosal disease), while the other 5(21.7%) patients remained with wet ears (2patients have cholesteatoma&3patients have an active mucosal disease).  -The intact canal wall technique was performed in 11(32.4%) patients & resulted in 5(45.5%) patients having dry ears (4patients have cholesteatoma &1patient had active mucosal disease), while the other 6(54.5%) patients remained with wet ears (all of them have an active mucosal disease). Conclusion  -It is evident that surgery performed in patients with chronic suppurative otitis media gives better chance for control infection. -Canal wall down technique is effective in the treatment of chronic suppurative otitis media with or without cholesteatoma - Cholesteatoma (55.8%) did significantly better than chronic mucosal disease (11.8%)


Merchant SN, Wang P, Jang CH, et al. Efficacy of tympanomastoid surgery for control of infection in active chronic otitis media. Laryngoscope 1997; 107:872–7.

Nadol JB, Schuknecht HF. Surgery of the Ear and Temporal Bone.New York: Raven, 1993.

Kinny SE. Intact canal wall tympanoplasty with mastoidectomy for cholesteatoma. Long term follow-up. Laryngoscope 1988;98:1190-4.

Males AG, Gray RF. Mastoid misery. Quantifying the distress in a radical cavity. Clin Otolaryngol 1991;16:12-4.

Joseph B. Nadol Jr, MD. Revision Mastoidectomy. Otolaryngol Clin N Am 2006; 39:723–740.

Palmgren O. Long term results of open cavity and tympanomastoid surgery of the chronic ear. Acta Otolaryngol 1979; 88 (5–6):343–9.

Pillsbury HC 3rd, Carrasco VN. Revision mastoidectomy. Arch Otolaryngol Head Neck Surg 1990;116(9):1019.

Palva T. 1962. Reconstriction of ear canal in surgery for chronic ear. Arch Otolaryngol 75 , 329.

Jansen , C. 1963. The combined approach for tympanoplasty. J. Laryngol Otol 82, 779.

Glasscock, M. E.III. 1977. Result s in cholesteatoma. First international conference. Iowa City, Iowa (ed. B. F. McCabe, J. Sade’ & M. Abramson) , pp.401-03.

Zollener, F., Altmann, F.(1978). Tympanoplasty, In:W. H. Maloney Otolaryngology: Otology, edited by M. English. New York. Harper and Row. Pp. 12/1-12/20.

Frootko, N. J. (1997). Recostruction of the middle ear, In Scott-Brown’s otolaryngology: otology, edited by J. B. Booth . Oxford. Butterworth-Heinemann. pp.3/11/1-3/11/19.

Smyth, G.D.L.(1972). Outline of surgical management in chronic ear disease. Otolaryngology Clinics of North America. 5:59-77.

Palva T, et al. The invasion theory in cholesteatoma and mastoid surgery. In: Sade J, ed. Cholesteatoma and mastoid surgery. Amsterdam: Kugler Publications, 1982:249-264.

Brackmann E, et al (2010). Otologic surgery, 3rd edn. By Saunders, Elsevier. pp: 195-220.

Nadol JB. Causes of failure of mastoidectomy for COM.Laryngoscope 1985; 95 :410-3.

Paparella et al. Mastoidectomy update. Laryngoscope 1977; 87:1977-88.

Sadề J. (1977). Postoperative cholesteatoma recurrence . 1st international conference. Iowa City, Iowa (ed. J. Sade et al) pp:384-89.

Sadề J. et al. (1982). The marsupialized (radical) mastoid. Journal of laryngology & otology; 96; 869-875.

Palva T. et al. (1977). Cholesteatoma surgery canal wall down & mastoid obliteration. 1st international conference. Iowa City, Iowa (ed. J. Sade et al) pp: 363-67.

Joseph, J. and Miles, Anne and Ifeacho, S. and Patel, N. and Shaida, A. and Gatland, D. and Watters, G. and Kiverniti, E. (2015) A Comparison of quality of life outcomes following different techniques of mastoid surgery. Journal of Laryngology and Otology 129 (09), pp. 835-839. ISSN 0022-2151.

Kurien M, Job A, Mathew J, Chandy M. Otogenic Intracranial Abscess: Concurrent Craniotomy and Mastoidectomy—Changing Trends in a Developing Country. Arch Otolaryngol Head Neck Surg. 1998;124(12):1353–1356. doi:10.1001/archotol.124.12.1353

Vartiainen E, Kansanen M. Tympanomastoidectomy for Chronic Otitis Media without Cholesteatoma. Otolaryngology–Head and Neck Surgery. 1992;106(3):230-234. doi:10.1177/019459989210600304

Lau T, Tos M, Tympanoplasty in children, American Journal of Otolaryngology, 1986; 7: 55–59.