Long-term results of open cavity and tympanomastoid surgery of the chronic ear.

The results of surgery for chronic middle ear infection in 307 patients (347 ears) are reported. All ears were operated on according to one of two procedures: (i) the operative cavity was left open after removal of the posterior canal wall, or (ii) a tympanomastoidectomy with intact canal wall was done. When necessary, removal of disease in the tympanum with or without reconstruction of the sound-conducting mechanism of the middle ear was performed. Cholesteatoma was present in 56% of the ears. Open cavity surgery with no reconstruction was done in 53%. In the remaining 47%, tympanomastoidectomy was performed and in approx. half of these ears reconstruction was undertaken. The postoperative follow-up period averaged 9 years. Residual cholesteatoma was found in 9%. In 4% of the ears undergoing tympanomastoidectomy a retraction pocket cholesteatoma developed. During the follow-up period 13% of the ears required revision surgery. Nineteen per cent of the ear with open cavities were discharging and, in addition, crusts were observed in 13%. In the tympanomastoidectomy group, discharing ears were seen in 26%. As a rule, hearing was not affected by surgery. The mean elevation of the pure tone threshold was 6.5 dB on account of sensorineural loss, while the speech reception threshold shift was 11 dB. The results testify to the importance of removing the posterior canal wall in ears with chronic middle ear infection associated with cholesteatoma.