A Study to Assess the Effect of Surgical Technique on Auditory Outcome Following Mastoidectomy

Background: A significant cause of preventable hearing loss is chronic otitis media (COM). The techniques employed in mastoidectomy, such as Canal Wall Up (CWU) and Canal Wall Down (CWD), can make significant improvements in auditory outcomes after the procedure. The objective is to assess and compare the auditory results after CWU and CWD mastoidectomy and the influence of the reconstruction material. Material and Methods: This prospective observational study comprised of 55 patients who had undergone mastoidectomy (CWU or CWD) with tympanoplasty for COM. Pure tone audiometry was performed preoperatively and at 3 weeks and 6 weeks, and again at 3 months. Results: Mean PTA improved from 42.6 ± 7.8 dB HL to 25.8 ± 5.9 dB HL, with mean gain of 16.8 dB. CWU showed significantly better hearing gain (18.1 dB) compared to CWD (14.2 dB) (p < 0.01). AB gap ≤20 dB was achieved in 72% (CWU) vs 58% (CWD). Reconstruction using temporalis muscle flap and cartilage-based techniques yielded better outcomes. Conclusion: CWU mastoidectomy provides superior auditory outcomes. Reconstruction materials play a significant role, and appropriate surgical selection is critical for optimal hearing restoration.

Keywords: Chronic otitis media, Tympanoplasty, Mastoidectomy, Ossiculoplasty, Hearing outcome, Air-bone gap.