The role of mastoidectomy in outcomes following tympanic membrane repair: a review.

OBJECTIVES/HYPOTHESIS: The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Some authorities suggest that outcomes are improved by the pressure buffering contributed by a well-aerated mastoid. It is unclear, however, whether or not clinical evidence demonstrates a benefit by the addition of a mastoidectomy. STUDY DESIGN: Review of peer-reviewed publications. METHODS: The literature on tympanoplasty and mastoidectomy was reviewed, examining the success of tympanic membrane repair, control of drainage, and hearing improvement. RESULTS: Twenty-six articles were reviewed examining surgical outcomes for patients with perforations resulting from chronic suppurative otitis media without cholesteatoma. Most of the literature consisted of retrospective cohort studies and case series with only a few small prospective randomized trials. Retrospective studies were commonly biased by performing mastoidectomy in ears with worse disease, and methodological differences made comparisons between studies difficult to interpret. There was no evidence of improved outcomes following mastoidectomy compared to tympanoplasty alone. Subgroup analysis, including actively discharging ears, extensive mucosal inflammation, large or repeat perforations, or sclerotic mastoids had overall worse outcomes. These patients showed a nonsignificant trend toward slightly improved results with mastoidectomy. CONCLUSIONS: The available literature shows no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated tympanic membrane perforations. Patients with more complicated disease may benefit from the addition of a mastoidectomy, but there is insufficient evidence to make a recommendation for this population. Further prospective controlled studies are needed.