Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life

Nora M Weiss, David Bächinger, Jannik Botzen, Wilma Großmann, Robert Mlynski, Nora M Weiss, David Bächinger, Jannik Botzen, Wilma Großmann, Robert Mlynski

Abstract

Objective: To assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration.

Methods: Patients who had undergone canal wall-down mastoidectomy for chronic otitis media with creation of a persistent mastoid cavity and underwent revision tympanomastoid surgery including mastoid cavity obliteration using autologous material were included. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air-bone gap (ABG) were assessed. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively.

Results: A total of 25 patients (16 females and 9 males; mean age 51.6 years, 14 right and 11 left ears) were included. Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. Compared to the preoperative visit, patients showed a significantly reduced AC PTA at the postoperative visit (mean difference: - 4.1; SD = 10.4, p = 0.045). The mean ZCMEI-21 score changed from 31.7 (SD = 14.5) preoperatively to 17.4 (SD = 15.1) postoperatively (mean difference: - 14.3; SD = 19.1; p = 0.0002). The mean ZCMEI-21 score changes were neither correlated to the AC PTA shift (p = 0.60) nor to the ABG shift (p = 0.66).

Conclusions: This is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. The improvement in HRQoL was not correlated to the hearing improvement. As a clinical implication, we provide evidence for a substantial subjective benefit of the surgical obliteration of a symptomatic mastoid cavity and, therefore, encourage this surgical procedure.

Keywords: Cholesteatoma; Chronic middle ear disease; Chronic otitis media; Mastoid cavity; Obliteration; ZCMEI-21.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Audiometric outcomes after mastoid cavity obliteration. Pre- and postoperative air conduction (AC) (a) and bone conduction (BC) (b) pure-tone average (PTA) as well as the air–bone gap (ABG). The bold line represents the mean; error bars indicate standard deviation
Fig. 2
Fig. 2
Pre- and postoperative ZCMEI-21 total scores. A lower ZCMEI-21 total score corresponds to a better HRQoL. The bold line represents the mean; error bars indicate standard deviation
Fig. 3
Fig. 3
Changes in the ZCMEI-21 subscores. Subscores include subscore I [ear signs and symptoms; (a)], subscore II [hearing; (b)] subscore III [psychosocial impact; (c)], and subscore IV [medical resources; (d)]. A lower ZCMEI-21 total score corresponds to a better HRQoL. The bold line represents the mean; error bars indicate standard deviation
Fig. 4
Fig. 4
Scatter plot showing the association between the ZCMEI-21 total score (a) and hearing subscore (b) changes and the AC PTA change

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