1998 Volume 8 Issue 1 Pages 19-23
Strategy regarding the appropriate choice of mode of ear surgery that we have established for these several years through several clinical observations of transmucosal gas exchange function and aeration of the middle ear, particularly mastoid in ears with otitis media was introduced in this review article. 1. Both mastoid gas exchange and aeration are lost after total mastoidectomy. 2. Loss of the gas exchange function and aeration in the mastoid may cause postoperative attic retration and possibly recurrent cholesteatoma. 3. If mastoidectomy is indicated, therefore, canal-wall-down procedure is safe, while canal-wallup procedure is justified only when mastoid mucosa can be preserved particularly around epitympanum. 4. Impaired mastoid gas exchange function due to accumulation of inflamed soft tissues in the mastoid may be improved by conservative treatment such as low-dose long-term macrolides, and such a preoperative treatment may contribute to minimizing the surgical intervention and the better postoperative course. 5. Such a minimally invasive surgery combined with conservative treatment should be considered further as a future prospect of ear surgery.
