Surgical modification of the difficult mastoid cavity.

This retrospective study used a computerized otologic database to identify patients undergoing revision surgery for a draining cavity unresponsive to medical therapy, with at least a 2-year follow-up. The surgical intervention involved partial mastoid obliteration and restoration of the middle ear space by use of cartilage reconstruction of the tympanic membrane. Ossicular reconstruction was achieved with either a partial or total ossicular replacement prosthesis. Because this technique involved contouring the mastoid cavity, the problems that usually occur, such as drainage or debris collection, were alleviated. In addition, re-establishment of the middle ear space often restored hearing. A completely dry cavity was achieved in 18 of 20 patients. An overall statistically significant improvement in hearing (P < 0.05) was obtained, with the mean pure-tone average air-bone gap decreasing to 16.1 dB from 36.5 dB. This technique has proven to be a useful adjunct in the surgical management of the chronically draining cavity.