Mastoid Obliteration Using S53P4 Bioactive Glass Versus Mastoidectomy Alone for Refractory Chronic Suppurative Otitis Media

Objective To present the outcomes of mastoid obliteration using S53P4 bioactive glass (BAG) for refractory chronic suppurative otitis media (CSOM) and compare these to mastoidectomy alone. Study Design Retrospective comparative cohort study. Setting Single-center study. Patients All cases that underwent a canal wall up (CWU) mastoidectomy between 2010 and 2022 for refractory CSOM. Inclusion criteria were refractory purulent otorrhea preoperatively as indicated by Merchant grade 2 or 3 despite conservative treatment for at least 6 months, at least 1 year of follow-up and mastoid involvement as indicated by subtotal or total opacification on the preoperative imaging. Patients with cholesteatoma were excluded. Intervention(s) Mastoid obliteration using S53P4 BAG. Main Outcome Measures(s) Merchant grade 1-year postoperatively, incidence of revision surgery during follow-up, frequency of tympanic membrane perforations, ventilation tube need, and audiological outcomes. Results In total, 124 obliteration cases and 84 non-obliteration cases were included. At 1-year postoperatively, the dry ear rate was 116 of 124 (94%) in the obliteration cohort and 71 of 84 (85%) in the non-obliteration cohort ( p = 0.02). Continuous discharge (merchant grade 3) was only observed in one non-obliteration case. During follow-up, revision surgery due to refractory otorrhea was necessary in none of the obliteration cases and 10 non-obliteration cases ( p < 0.001). The frequency of tympanic membrane perforations, ventilation tube need, and audiological results were comparable between the two groups. Conclusions Our study indicates that for refractory cases of CSOM, mastoid obliteration using BAG results in superior outcomes compared to mastoidectomy alone. It results in significantly less postoperative otorrhea and revision operations and should therefore be considered. Level of Evidence 3.