Outcomes of Tympanoplasty with or without Cortical Mastoidectomy in CSOM with Active Mucosal Disease

Abstract

Background: Chronic suppurative otitis media (CSOM) with active mucosal disease presents a surgical challenge regarding optimal management approach. The role of cortical mastoidectomy in conjunction with tympanoplasty remains debated, particularly concerning graft uptake and audiological outcomes.
Objective: To compare graft uptake rates and hearing improvement between tympanoplasty alone versus tympanoplasty with cortical mastoidectomy in patients with CSOM and active mucosal disease, and to evaluate the efficacy of different graft materials.
Methods: A comparative observational study was conducted at a tertiary care center involving 98 patients with CSOM and active mucosal disease. Patients underwent either tympanoplasty alone (n=49) or tympanoplasty with cortical mastoidectomy (n=49). Graft materials included temporalis fascia alone or temporalis fascia with conchal cartilage. Primary outcomes were graft uptake at 3 months post-operatively assessed by otoendoscopy and hearing improvement measured by pure tone audiometry.
Results: Graft uptake was significantly superior in the mastoidectomy group (100% with fascia+cartilage, 81.8% with fascia alone) compared to tympanoplasty alone (96.6% with fascia+cartilage, 65% with fascia alone). Mean hearing improvement (pure tone average) was greatest in the mastoidectomy with fascia+cartilage group (17.40 ± 9.61 dB) compared to other groups. Air-bone gap improvement showed similar patterns. All differences were statistically significant (p <0.05).
Conclusion: Cortical mastoidectomy significantly improves both graft uptake and hearing outcomes in CSOM with active mucosal disease. Cartilage addition improves outcomes and should be considered in all cases.