title: Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media: Literature Review and Cost Analysis.
abstract: Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management.
  
  
  
  PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science.
  
  
  
  A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic.
  
  
  
  From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit.
  
  
  
  Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA ATrinidade@uams.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Trinidade
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Page
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Dornhoffer
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000191:economics* / Q000379:methods; D014481:United States
keywords: atelectasis; chronic otitis media; cost analysis; mastoidectomy; retraction pocket; tympanic perforation