EFFICACY OF TYMPANOMASTOID SURGERY FOR CONTROL OF INFECTION IN ACTIVECHRONIC OTITIS-MEDIA

The efficacy of surgery in controlling infection in 272 tympanomastoid ectomy procedures for chronic otitis media (COM) was assessed by means of a four-point rating scale that incorporated both symptoms and sign s, such as the presence or absence of otorrhea and granulation tissue. Of the 272 procedures, 170 were performed for COM with cholesteatoma and 102 were for active COM with granulation tissue but no cholesteato ma. Forty-seven percent were primary procedures, and 53% were revision s. Minimum follow-up was 12 months for all cases, with a mean of 30 mo nths. Adequate control of infection occurred in 248 (91%) of the 272 c ases. Of the 24 cases (9%) that developed persistent infection, 10 wer e controlled with a combination of oral and topical antibiotics and/or delayed skin grafting in the office. Thus overall satisfactory contro l of infection was achieved in 258 of 272 cases (95%). The outcome was influenced by the diagnostic category of COM: COM with cholesteatoma did significantly better than COM with granulation tissue (P = 0.02). The outcome was not influenced by the following variables: primary ver sus revision surgery, canal wall-up versus canal wall-down surgery, an d extent of disease. The results suggest that active COM with granulat ion tissue may be more difficult to control than COM with cholesteatom a.