Is simultaneous bilateral mastoidectomy ever advisable?
BACKGROUND
We report our experience with bilateral, simultaneous tympanomastoidectomies and the results of an opinion survey of otologists.


METHODS
A chart review of 116 tympanomastoidectomies revealed 12 patients who underwent bilateral, simultaneous tympanomastoidectomies. An opinion survey generated 121 responses.


RESULTS
Of the 12 patients, none suffered any outcome which would have been avoided by staging the procedures. Twenty-three of 24 operated ears had the same or better hearing post-operatively. Of the survey respondents, 74 felt that performing bilateral, simultaneous tympanomastoidectomies was unsafe, largely because of the risk of bilateral sensorineural hearing loss.


CONCLUSIONS
Although bilateral, simultaneous tympanomastoidectomies carry double the risk of unilateral sensorineural hearing loss, compared with the unilateral procedure, the risk of bilateral sensorineural hearing loss is only 0.006-0.2 per cent, as derived mathematically from historical data. Respondents to the survey were mostly opposed to bilateral, simultaneous tympanomastoidectomies, but even those opposed gave indications for simultaneous procedures. This finding probably reflects an ambivalence about the theoretical risks of the operation versus the potential patient benefits. A decision tree for proceeding to the second case is presented.
Klemens
J J
JJ
Section of Otolaryngology, Department of Surgery, University of Chicago, Chicago, Illinois, USA.
Mhoon
E
E
Redleaf
M
M
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003663:Decision Trees; D004427:Ear Diseases / Q000150:complications / Q000601:surgery*; D034381:Hearing Loss / Q000175:diagnosis / Q000209:etiology; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012306:Risk; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000009:adverse effects*