Assessment of total middle ear reconstruction by patient survey correlated with clinical findings Anting Xu, Shin-ichi Ishimoto, Ken Ito, Tatsuya Yamasoba, Kimitaka Kaga * Department of Otolaryngology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Received 8 March 2002; received in revised form 15 August 2002; accepted 20 September 2002 Abstract Objective: Our objective was to assess, by patient survey and clinical examination, the results of correctional total middle ear reconstruction of problematic mastoid cavities following radical or modified radical mastoidectomy. Setting: This study was performed in an academic tertiary referral center. Patients: The study consisted of a retrospective survey, using the modified hearing satisfaction scale, of 50 patients, who had undergone total middle ear reconstruction of their problematic mastoid cavities. The survey results were correlated with their postoperative clinical findings. Results: Postoperatively, 98% of these patients expressed satisfaction in terms of improvement of their preexisting otorrhea (median of 4.32 satisfied), 65% were satisfied with their hearing and 85% were satisfied with the overall of this operation. The survey results had a good correlation with the audiometric findings and the clinical findings, i.e. the surgery resulted in a dry ear in all 50 patients and 51% of these patients showed hearing improvement of more than 5 dBHL. Conclusions: This study indicates that most patients were satisfied with the outcomes of this operation. The patients’ point of view and the postoperative clinical data both indicate that total middle ear reconstruction is an excellent procedure for correcting problematic mastoid cavities following a radical or modified radical mastoidectomy. The hearing satisfaction scale is a useful instrument for assessing patient satisfaction following this surgical procedure. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Mastoidectomy; Hearing satisfaction scale; Revision operation; Hearing; Total middle ear reconstruction 1. Introduction Intermittent or persistent discharge from mastoid cavities following radical or modified radical mastoi- dectomy has been reported to occur in approximately 65% of such cases [1]. Palva [2] reported that, due to continuous or recurring infection, these cavities dis- charged chronically in 10% of his cases and remained occasionally moist in 20%. Management of this problem generally includes local cleaning of the mastoid cavity, revision surgery and cavity elimination. Cavity elimina- tion includes ablation (closure of the external auditory canal) [3,4], obliteration (filling of the cavity) [5] and total middle ear reconstruction (posterior ear canal wall reconstruction with tympanoplasty) [6  /8]. Total middle ear reconstruction is the most complex of these techni- ques but it is the best method for treating problematic mastoid cavities [9  /11]. The total middle ear reconstruction method is a good surgical procedure for such patients in order to eradicate an infected mastoid cavity, and/or middle ear and to improve hearing. The total middle ear reconstruction surgery, which includes reconstruction of the posterior external ear canal for the large open cavity with otorrhea and reconstruction of the ossicular chain for hearing improvement [10,11]. Routinely, middle ear surgery outcome is reported only in terms of the postoperative audiometric hearing improvement. This is certainly relevant in that it enables assessment of the technical success of the procedure and provides an indication of a patient’s postoperative aural disability. Following total middle ear reconstruction, surgical outcome is determined by several other factors in addition to audiometric factors. As such, a patient- based outcome survey provides a better understanding of the results of the operation from the patients’ point of * Corresponding author. Tel.:  /81-3-5800-8665; fax:  /81-3-3814- 9486. E-mail address: kimikaga-tky@umin.ac.jp (K. Kaga). Auris, Nasus, Larynx 30 (2003) 15 /20 www.elsevier.com/locate/anl 0385-8146/02/$ - see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0385-8146(02)00101-3