Mastoid cavity obliteration in revision tympanomastoidectomy with ossiculoplasty for chronic cholesteatomatous otitis media: a retrospective case series on audiological and patient-reported outcomes

Objective: Mastoid cavity obliteration is a surgical strategy rather than an intervention per se, that has been proposed as an effective approach to reduce post-operative complications and long-term morbidity associated with canal wall down (CWD) tympanomastoidectomies. The present study aims to evaluate, in a retrospective case series, audiological, functional, and quality-of-life (QoL) outcomes in adult patients undergoing revision tympanomastoidectomy and ossicular chain reconstruction with mastoid obliteration. Materials and methods: A retrospective analysis was performed on a cohort of patients affected by recurrent cholesteatomatous chronic otitis media (CCOM) who underwent revision tympanomastoidectomy, ossiculoplasty, and mastoid cavity obliteration in the same surgical session. Inclusion criteria were age >18 years and a minimum follow-up of 12 months with available pre- and postoperative audiometric data. Audiological outcomes were assessed using mean pure-tone average (PTA, 250–4000 Hz) and air–bone gap (ABG), calculated over the same frequency range and consistently applied to all cases. QoL was evaluated pre- and postoperatively using the validated Italian versions of the Chronic Otitis Media Outcome Test-15 (COMOT-15) and the Chronic Ear Survey–Italian version (CES-I), scored according to their original validated format. Outcomes were also compared, as an exploratory analysis, in a subgroup analysis between patients receiving partial ossicular replacement prostheses (PORP) and total ossicular replacement prostheses (TORP). Results: Fourteen of eighteen eligible patients (6 males, 8 females; mean age 45.4 years) met the established inclusion criteria, completing both audiological and QoL assessments. Mastoid obliteration was performed using different autologous or synthetic biocompatible materials, whose choice was based on intraoperative findings and surgeon preference. A significant improvement in mean PTA was observed postoperatively (66.7 ± 5.3 dB preoperatively vs. 53.8 ± 7.3 dB postoperatively; p < 0.05), as well as a significant reduction in ABG (34.5 ± 7.3 dB vs. 22.3 ± 10.8 dB; p < 0.05). Greater audiological improvement was noted, in this small and non-randomized subgroup comparison, in patients rehabilitated with PORP compared to TORP. QoL scores, based on patient-reported questionnaires, significantly improved at 12 months postoperatively, with CES-I scores increasing (30.5 ± 11 vs. 76 ± 14.2; p < 0.01) and COMOT-15 scores decreasing (78.7 ± 15.7 vs. 40.5 ± 20.8; p < 0.01), particularly in domains related to activity limitation. Conclusion: Mastoid cavity obliteration combined with ossiculoplasty in revision tympanomastoidectomy was associated – in our retrospective analysis – with postoperative improvement in hearing outcomes and QoL, with greater audiological improvement observed in patients reconstructed with PORP. Because of the small sample size, heterogeneous obliteration materials, and the absence of a non-obliterated control group, our findings are preliminary and explanatory, and warrant confirmation in larger, prospective, controlled studies to fully demonstrate the independent or causal benefit of mastoid obliteration.