Surgery of the mastoid in ears with middle ear effusion.

It has been demonstrated that in most ears with middle ear effusion the mastoid air cells may be involved as well. The mucosal changes and the secretion extends into all cavities of the ear including the mastoid air cells. In most ears insertin of a ventilating tube through the tympanic membrane is adequate for proper aeration of the middle ear as well as of the mastoid air cell system. The draining usually stops and the mucosa gradually changes into its normal condition. In a small percentage of these, the ear will continue to drain and the mastoid will not clear up. Antibiotics and decongestants fail to cure the ear. Surgical intervention of the mastoid may be indicated in the rare cases where conventional treatment fails to control the condition. The aim of this report is to 1) focus attention to the fact that the mastoid is an integral part of the middle ear cavity; 2) discuss the pathogenesis in stubborn ears with middle ear effusion; and 3) demonstrate the surgical procedure commonly used in our department in order to reestablish aeration of the mastoid air cell system. Early recognition and proper treatment of ears with middle ear effusion will hopefully reduce the incidence of stubborn cases and also decrease the number of those cases which end up with chronic otitis media and cholesteatoma. It is hoped that the screening programs involving school and even preschool children, as well as new preventative programs, will diminish the frequency of cases which need extensive surgery as discussed in this paper.