Usually, standardized questionnaires investigating everyday life situations, difficulties in communication or social contacts, and co-symptoms like tinnitus are used to assess the impairment due to hearing handicap. Moreover, patient-reported outcome measures are being used increasingly and have gained importance to measure therapeutic success. Therefore, focusing on the audiological outcome alone may only insufficiently assess the surgical results. It has to be assumed that the patient’s subjective benefit from tympanomastoid surgery is not only determined by the postoperative reduction of the air–bone gap (ABG). Furthermore, it has been reported that hearing impairment is a major risk factor for the development of dementia and cognitive dysfunction.

In cases of a persistent mastoid cavity, symptoms such as chronic ear discharge, ear pain, and hearing impairment may severely impair patient’s health-related quality of life (HRQoL). However, the mechanism of biomaterial-based regeneration processes has still to be understood and recent work concerning allogeneic materials showed an insufficient cavity obliteration and high rates of revision surgery. Additionally, several xenografts and alloplastic materials have been designed and tested in clinical and experimental settings. Drawback of autologous material may be natural shrinkage and the limited availability of after repeated revision surgery. Cartilage, either from the concha, tragus or nasal septum, muscle flaps, bone pâté or fascia are used. Usually, the use of autologous material is preferred due to its good biocompatibility. Multiple methods and materials for cavity obliteration, which is commonly performed in combination with meatoplasty, have been developed and tested. In these cases, the treatment of choice consists of the secondary surgical obliteration of the mastoid cavity as first described by Mosher in 1911. Depending on the extent of the mastoid cavity and the size of the external auditory canal, the self-cleaning process of the mastoid cavity may be disturbed, leading to recurrent infections, secretion, vertigo, hearing impairment, and frequent consultation of an ENT specialist. Nowadays, the primary creation of a mastoid cavity is performed as part of a canal wall-down mastoidectomy in cases of large cholesteatoma or inflammatory processes inside the mastoid. Historically, in extended inflammation processes of the middle ear and mastoid, an open mastoid cavity was created without reconstruction under the aim of draining the disease into the bony outer ear canal. 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. The improvement in HRQoL was not correlated to the hearing improvement. This is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. 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). 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). Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. ResultsĪ total of 25 patients (16 females and 9 males mean age 51.6 years, 14 right and 11 left ears) were included. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air–bone gap (ABG) were assessed. 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. To assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration.

Mastoid obliteration