Author(s)
Joel William Jones, MD MBA
Todd Hillman, MD
Douglas Chen, MD
Affiliation(s)
Pittsburgh Ear Associates;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the outcomes for mastoidectomy with indwelling antibiotic catheter irrigation in patients with chronic otorrhea.
Objectives: To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea or a draining perforation.
Study Design: Retrospective chart review.
Methods: A retrospective chart review from 2001-2020 was performed on 25 patients and 26 ears that underwent mastoidectomy with placement of a temporary indwelling catheter for persistent otorrhea. All patients had failed outpatient medical management and had preoperative imaging. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0 or 1 episodes of otorrhea or resolving otitis media with effusion during followup), improvement (2 - 3 episodes), or failure ( >3 episodes).
Results: Median age was 45 years (interquartile range, IQR=29-60). There were 22 draining ears (85%) with a tympanostomy tube and 4 with a perforation. The median duration of otorrhea from referral was 4 months (IQR=2-10). Fifteen ears had resolution of drainage, 7 had improvement, and 4 failed. The observed percentage of resolved/improved ears (85%) was significant (P<.001, 95% CI=63.5-93.9%). Median followup time was 24 months (IQR=12-50.5). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, P=.01) with no difference in word recognition scores (P=.76). Methicillin resistant staphylococcus aureus was the most common isolated microbe on available preoperative cultures while no growth was most frequently noted on intraoperative culture.
Conclusions: Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy in patients with persistent otorrhea who have failed topical and oral antibiotics. Failures in this study were associated with patients who had an immunocompromised state.