2023 Volume 116 Issue 8 Pages 825-832
Postoperative discomfort, such as autophony or hyperacusis, is sometimes reported following surgery in which the posterior fossa dura membrane becomes exposed to the mastoid cavity. We report two patients with postoperative hearing discomfort who were successfully treated by mastoid cavity obliteration.
Case 1: A 35-year-old man who had undergone endolymphatic sac decompression surgery on the left side for Meniere’s disease 3 years prior to his first visit to our department. While the patient had obtained relief from the vertigo, he developed postoperative hyperacusis caused by pressure on the posterior left ear and autophony. Communication between the posterior cranial fossa and the mastoid cavity was delineated on a computed tomographic (CT) image. Mastoid cavity obliteration was performed under general anesthesia. The mastoid cavity was obliterated with sliced auricular cartilage and granular hydroxyapatite. The hearing discomfort improved within 1 month after the operation, and no exacerbation has been noted after the surgery.
Case 2: A 59-year-old woman who had undergone the Jannetta surgery for left hemifacial spasm 1 month prior to her first visit to our department. She was referred to our department because of postoperative hyperacusis caused by postauricular pressure and autophony in the left ear. Since CT revealed a communication between the posterior fossa and the mastoid cavity, the mastoid cavity was obliterated with sliced auricular cartilage and granular hydroxyapatite. The left ear discomfort disappeared within 1 month after the operation, and no exacerbation has been observed until now, 1year after the surgery.
Mobility of the dura membrane of the posterior fossa that had become exposed to the middle ear cavity during the previous surgery may explain the uncomfortable sensation reported by the patients. If the posterior fossa dura membrane becomes exposed to the mastoid cavity due to surgical procedures and the resulting ear discomfort is severe, mastoid cavity obliteration may be recommended to resolve the symptoms.
