Learning Objectives: To collate a review of our experience with mastoid obliteration over the last ten years. Evaluate the cost effectiveness of mastoid obliteration in the chronically discharging ear.
Introduction: The chronically discharging ear after open mastoid surgery for cholesteatoma can be problematic to manage for the Otolaryngologis requiring numerous appointments. In the current climate of cost saving within the NHS, we must balance clinical evidence and cost. We review our practice of Mastoid obliterations in our district general hospital in the UK over the last ten years to look at both success and cost.
Methods: All the notes of patient who had mastoid obliteration over the last ten years were reviewed. The cases were found by going through the theatres scheduling records. We reviewed the preoperative, intraoperative and postoperative course of each patient. We report on our technique, the success rate of improving symptoms, audiogram changes and complications. We compare the monitory costs of the patient's preoperative versus operative and postoperative costs.
Results: There were 14 patients, six male and eight female with an mean age of 46.7years. They had been listed for mastoid obliteration due to chronically discharging ear. All mastoid cavities were obliterated with bone dust, fat and fascia lata graft. Postoperatively patients reported their symptoms had improved and some also reported quality of life improvement including confidence and embarrassment in social situations. Subjectively some patients even reported their hearing had improved and leaving a small dip in the obliterated cavity of the external auditory canal for a conventional ear-level hearing aid was a bonus for patients. Patients preoperative costs and therefore presumed continued costs, justified the operation and postoperative costs.
Conclusions: We conclude that in the correct patient group mastoid obliterations are beneficial to both the patient and the NHS.
