The Role of Concomitant Mastoidectomy in Improving Outcomes Following Tympanic Membrane Perforation Repair: A Systematic Review

Abstract
Background: The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, others argue that performing mastoidec-tomy in these patients is unnecessary, does not improve surgical outcomes, and subjects patients to increased surgical risks.
Aim of the Work: To assess the effectiveness and safety of performing routine cortical mastoidectomy in addition to tympanoplasty in treatment of tympanic membrane perforation in cases of chronic suppurative otitis media in the absence of cholesteatoma.
Patients and Methods: Five randomized controlled trials with total of 610 participents were included of any age with chronic suppurative non cholestaetomatous otitis media, divided into two groups: Group A (received Tympanoplasty alone), Group B (Tymanplasty with cortical mastoidectomy).
Five outcomes measured namely (healing rate,hearing rate, tympanometric evaluation, rate if otorrhea, need for subsequent procedure).
Results: Articles reporting results of concomitant mas-toidectomy with tympanoplasty were identified. Five articles satisfied our eligibility criteria, there was no significant heterogeneity. Compared to the conventional method tympan-oplasty with cortical mastoidectomy was found to have a significantly higher rate of healing (odds ratio of 1.762 with a 95% CI of –1.115 to 2.787, no significant difference in post-operative air bone gap (SMD of .056 with 95% CI of –0.110 to 0.222), no significant difference in rate of otorrhea (odds ratio of 1.949 with a 95% CI of 0.528 to 7.192, no significant difference in post-operative tympanometry (odds ratio of type A, Astympanometry was 0.777 and a 95% CI of 0.278 to 2.179, no significant difference in rate of revision surgery (odds ratio 2.069 and a 95% CI of 0.178 to 24.075.
Conclusions: From the result s of our systematic review we advise for the use of tympanoplasty alone for treatment of non cholesteatomatous chronic otitis media.