Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

OBJECTIVE: This study aimed to compare outcomes for mastoidotympanoplasty and for tympanoplasty alone in cases of quiescent, tubotympanic, chronic, suppurative otitis media. STUDY DESIGN: Single-blinded, randomised, controlled study within a tertiary referral hospital. METHODS: Sixty-eight cases were randomly allocated into two groups. In group one, 35 ears underwent type one tympanoplasty along with cortical mastoidectomy. In group two, 33 ears underwent type one tympanoplasty alone. Outcome measures were as follows: perforation closure and graft uptake, hearing improvement, disease eradication, and post-operative complications. RESULTS: There were no statistically significant differences in hearing improvement, tympanic perforation closure, graft uptake or disease eradication, comparing the two groups at three and six months post-operatively. CONCLUSION: Mastoidotympanoplasty was not found to be superior to tympanoplasty alone over a short term follow-up period. Hence, it may not be necessary to undertake routine mastoid exploration at this stage of disease.

Invasive sino-nasal pseudallescheriasis in a non-immunocompromised patient.

Pseudallescheriasis is a spectrum of clinical diseases involving Pseudallescheria boydii, a soil and water inhabiting fungus. The organism is of low virulence, but is a fungal opportunist able to elicit infections similar in terms of variety and pre disposing factors to those of Aspergillus species(3). Involvement of the nose and the sinuses is very rare(7). Here we present a case of invasive Pseudallescheriasis involving the nose, paranasal sinuses and orbit in a non-immunocompromised person. Surgical debridement followed by systemic antifungal therapy was given. The fungus resembles hyaline moulds like Aspergillus very closely in tissue sections and can be a diagnostic challenge to the pathologist.