Day-case management of chronic suppurative otitis media with cholesteatoma with canal wall down technique surgery: long-term follow-up

The overall number of day-case otologic surgery cases is increasing; however, there is limited experience about performing canal wall down tympanoplasty in patients with chronic suppurative otitis media with cholesteatoma in this setting. The objective of this study was to assess the success of this technique as daycase surgery in terms of results and complications over an 8-year follow up period. We included in this study 42 patients undergoing canal wall down technique tympanoplasty surgery for chronic suppurative otitis media with cholesteatoma performed as day cases during a 2-year period. 30 cases (71.4%) were discharged on the day of surgery, whereas 12 cases (28.6%) were hospitalized and discharged the day after. The principal reasons for failure of discharge on the day of surgery were asthenia (6 cases), vertigo and asthenia (4 cases), undetermined (2 cases). Based on our experience, with a proper preoperative selection, assessment and screening of the patients, mastoidectomy with timpanoplasty for chronic suppurative otitis media with cholesteatoma can be carried out in a day surgery setting with no significant effects on effectiveness of surgery, post-operative symptoms and relapse of disease even in the long term. Introduction Many procedures that in the past typically required overnight hospital stay are now being performed in a day surgery setting. Management of specific conditions using day-case surgery has several advantages over inpatient surgery, such as reduced risk of hospital infection, better quality of life, shorter waiting time, and economic savings for the National Health Service. The American Academy of Otolaryngology Head and Neck Surgery has published a suggested list of procedures deemed appropriate for outpatient settings, including many otologic procedures such as myringoplasty, tympanoplasty, simple mastoidectomy, stapes surgery, middle ear exploration and reconstruction of the external ear.1 The overall number of day-case otologic surgery cases is increasing despite the complexity of same day hospital discharge, especially for stapes surgery,2,3 myringoplasty,4,5 and tympanomastoid surgery.6,7 There is less experience in day-case surgery for chronic suppurative otitis media (CSOM) with cholesteatoma.8 The type of surgical procedure is one variable that can significantly influence the nature of the postoperative course and the rate of postoperative complications; complex procedures, such as tympanomastoid surgery, may have a different postoperative course compared to other surgical procedures.9 The three main reasons for failure of patient discharge on the day of surgery after otologic surgery are vertigo, vomiting, and asthenia.2 The incidence of postoperative nausea and vomiting (PONV) in patients undergoing day surgery is approximately 35%;10 however, for patients undergoing otologic surgery it can be as high as 80%.11 Various experiences highlight that prophylactic administration of antiemetic drugs does not seem to influence the incidence of PONV requiring hospital admission. Other factors associated with the management of otologic surgery in a day case setting are the length of general anesthesia (≥ 2 h), the distance between home and hospital, age, poor health and asthma or breathing difficulties as coexisting conditions.11,12 In this paper, we report our experience on canal wall down (CWD) tympanoplasty in patients with CSOM with cholesteatoma performed in the day surgery unit (DSU) of a large Italian hospital with an 8-year follow up. This study included only cases of cholesteatoma treated with a standardized canal wall down tympanoplasty technique and managed as day-case surgery cases. The aim of this paper is to assess the success of this technique in a day case setting in a large Italian hospital with a long-term follow-up. Correspondence: Massimo Ralli, Department of Oral and Maxillofacial Sciences, La Sapienza University, viale del Policlinico 155, 00186