Das Chiranjib, Hazra Tapan Kanti
RMO Cum Clinical Tutor, BSMCH, Bankura, India.
Ramkrishnapally, Batanagar, South 24 Parganas, 700140 India.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 2):1107-1114. doi: 10.1007/s12070-017-1198-y. Epub 2017 Sep 5.
Canal wall down (CWD) mastoidectomy is the operation of choice for unsafe variety of chronic otitis media. But open mastoid cavity poses many problems. The solution of these problems is obliteration of mastoid cavity that is self-cleaning and easily maintained. In our study we aim to establish the effective technique for mastoid cavity obliteration in CWD mastoidectomy and review its efficacy in producing a dry, low maintenance cavity. This was a non-randomized longitudinal prospective study, performed over 2½ years in the department of ENT in a tertiary care hospital of Kolkata. Patients of chronic otitis media unsafe variety within the age group of 16-60 years were included in our study. Chronic otitis media unsafe variety with intratemporal or intracranial complications, and extensive cholesteatoma or granulation tissue that can't be cleared completely during operation were excluded. There was no statistical significance for hearing improvement between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. There was significant statistical significance for obliteration of cavity, epithelized cavity and dry cavity between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. Persistent discharge and granulation were significantly more in non-obliterated group. The time taken by the ear to become dry is much shorter after mastoid cavity obliteration. Moreover, lifelong aural toilet and dependence on an ENT surgeon is avoided. Inspite of all these, a few pre-conditions must be fulfilled before embarking on this type of surgery.
开放式乳突根治术（CWD）是治疗不安全型慢性中耳炎的首选手术。但开放的乳突腔会带来许多问题。解决这些问题的方法是乳突腔封闭术，该方法可实现自我清洁且易于维护。在我们的研究中，我们旨在建立一种有效的技术用于开放式乳突根治术中的乳突腔封闭，并评估其在形成干燥、易于维护的乳突腔方面的疗效。这是一项非随机纵向前瞻性研究，在加尔各答一家三级护理医院的耳鼻喉科进行了两年半。年龄在16 - 60岁之间的不安全型慢性中耳炎患者被纳入我们的研究。排除患有颞内或颅内并发症的不安全型慢性中耳炎患者，以及手术过程中无法完全清除的广泛胆脂瘤或肉芽组织患者。未进行封闭的开放式乳突根治术与进行封闭的开放式乳突根治术在听力改善方面无统计学差异。未进行封闭的开放式乳突根治术与进行封闭的开放式乳突根治术在乳突腔封闭、上皮化乳突腔和干燥乳突腔方面有显著统计学差异。未封闭组的持续性耳漏和肉芽明显更多。乳突腔封闭后耳朵变干所需的时间要短得多。此外，避免了终身耳部清理以及对耳鼻喉科医生的依赖。尽管如此，在开展这类手术之前必须满足一些先决条件。
