EFFICACY OF CORTICAL MASTOIDECTOMY IN TYMPANOPLASTY: A COMPARATIVE STUDY

Abstract

Background: Chronic Suppurative otitis media (CSOM) is a prevalent cause of hearing loss in developing countries. Tympanoplasty is widely accepted for tympanic membrane repair; however, the benefit of adding cortical mastoidectomy in patients with sclerotic mastoids remains uncertain.

Objective: To compare surgical outcomes—specifically graft uptake, hearing improvement, and postoperative wound healing between patients undergoing tympanoplasty alone and those undergoing tympanoplasty with cortical mastoidectomy.

Material and Methods: This comparative study was conducted over six months in the Department of Otorhinolaryngology at Lady Reading Hospital, Peshawar. A total of 56 patients aged 15 years and above with dry central perforations and radiological or intraoperative evidence of sclerotic mastoids were included. Patients were divided into two groups: Group A underwent tympanoplasty alone, and Group B underwent tympanoplasty combined with cortical mastoidectomy. Graft uptake at 3 months was the primary outcome. Secondary outcomes included air–bone gap (AB-gap) improvement on pure tone audiometry, air and bone conduction thresholds, wound healing status, and postoperative complications. Data were analyzed using SPSS version 26, with significance set at p ≤ 0.05.

Results: At the 3-month follow-up, graft uptake was higher in Group B (96.4%) compared to Group A (71.4%) (p = 0.011). Group B also showed significantly greater AB-gap improvement (18.40 ± 4.91 dB) than Group A (10.09 ± 5.55 dB, p < 0.001). Air conduction thresholds were also better in Group B (p = 0.008). Postoperative complications were infrequent and similar between groups.

Conclusion: This comparative study suggests that the addition of cortical mastoidectomy to tympanoplasty may lead to improved graft uptake and audio logical outcomes in patients with sclerotic mastoids. These findings support the consideration of cortical mastoidectomy in selected cases of CSOM with poor mastoid pneumatization.