Canal-down mastoidectomy: experience in 81 cases.

OBJECTIVES To identify the common presentation(s) and the clinical and operative finding(s) in patients with cholesteatomatous and long-term noncholesteatomatous chronic suppurative otitis media and to adapt a surgical management best suited to ensure long-term safety in these Papua New Guinean patients for whom postoperative follow-up is minimal. DESIGN Retrospective case series. SETTING Port Moresby General Hospital, the tertiary referral center for otolaryngologic services. PATIENTS Eighty-one patients in all age groups who received a clinical diagnosis of chronic suppurative otitis media, with or without cholesteatoma, with or without its associated complications. INTERVENTION Canal-down (modified radical) mastoidectomy with wide meatoplasty. MAIN OUTCOME MEASURE AND RESULTS Adults were more commonly affected than adolescent or pediatric cases, and there was a male preponderance. The median age was 24 years (range, 13 months to 73 years). Otorrhea remained the most common presentation in all age groups. Postauricular abscesses and fistulae were seen frequently. Cholesteatoma and granulation with polypoidal mucosa were frequent operative findings; a high incidence involved both the attic space and the antrum. Five (6%) patients had preoperative facial paralysis; in addition, postoperative facial paralysis developed in three (4%) patients. The incidence of postoperative "wet ear" was high in all age groups. Meningitis was the most common intracranial complication, followed by lateral sinus thrombosis. There were seven (9%) deaths altogether, and all the deaths occurred as a direct result of otogenic intracranial complication. CONCLUSION Lack of health consciousness, poor socioeconomic status, and lack of health care delivery system resulted in late presentations and poor postoperative follow-up. Hence, the canal-wall-down technique with wide meatoplasty is recommended to ensure a best possible one-time treatment in Papua New Guinean patients with cholesteatomatous or long-term "dangerous" chronic suppurative otitis media with or without complications.