Can Timely Mastoidectomy Prevent Development of Secretory Otitis? Summary

Overview

The aim of the work was to evaluate a group of mastoidectomies executed over the period of ten years in view of peroperative findings anamnestic factors.

Retrospective analysis of the group of patients operated on at the clinic in the years 1996 – 2005 was performed. There were 261 cases of antromastoidectomy in 196 patients performed in this period of time. The mean age was 40 months and the mean number of acute Otitis was five. The following factors occurred in anamnesis most frequently: GER, immunodeficit, polyvalent allergy, agranulocytosis, bronchial asthma. The most frequent peroperative finding was an obturating granulation in 79%. Puruluence was observed in 28%, sclerotizing of the bones in 24% and subperiostal abscess in 14%. Dura mater was uncovered by the inflammatory process in 4%, sinus in 3%. The authors draw attention to the fact that the deamage was caused by inflammatory process and no iatrogenic damage took place. In 15% Mastoidectomy for lateral mastoiditis was accompanied by adenotomy, tympanostomy was int6roduced in 13%. The facial nerve paresis before the intervention was observed in 5% of cases. Sampling for bacteriology was performed in 92% of cases, 43% of them being negative from bacteriological point of view. Streptococcus pneumoniae was determined in 33%, followed by Hemophilis influenzae in 25%, there was surprisingly Pseudomonas aeruginosa present in 12.5% of positive smears. The other pathogens included Klebiella spp., Enterobacter, Staphylococcus aureus, Streptococcus pyogenes, and Proteus Hauseri.

The authors made an effort to evaluate the number of possible relapses of acute Otitis after the performed Mastoidectomy, but the results were not of sufficient precision for the low rate of follow up examinations of the patients. In spite of that there were a very low number of relapses of acute Otitis in patients, where mastoidectomy was indicated during the first otitis in life and that with peracute course. There was a surprising long-term annual decreased of the mastoidectomies performed (Fig.). On the other hand there was an apparent marked increase in the number of interventions performed in connection with sclerotic otitis – paracentesis and draining of the middle ear secret, tympatostomy, and Armstrong drainage (Figure 2).

Mastoidectomy is still considered as an important intervention in otolaryngology despite advanced antibiotic therapy. Obturating granulations are the most frequent peroperative findings especially those in the area of aditus ad antrum. The most frequently cultured pathogen in the area of mastoidal cavity proved to be Streptococcus pneumoniae, followed by Hemophilus influenzae in the second place. The most outcome of the correctly performed mastioidectomy is the restoration of communication between mastoidal and tympanic cavity. The decrease in the rate of performed mastoidectomies and, on the contrary, a marked increase in the number of interventions associated with secretory Otitis is not considered as an accidental phenomenon. The intervention has been indicated on individual basis and the speed of tympanometric findings to return to normal between individual attacks of otitis for suspected latent ostitic changes is considered important. The most contributing and most effecte imaging method is, in our opinion, still classical X-ray projection according to Schuller, Mayer or Rossman. In the borderline conditions we prefer to operate on the patients sooner.

Key words:
mastoidectomy, secretory otitis, relapsing otitis.