Intact Bridge Mastoidectomy: A Hybrid Approach as a Middle-Ground Between Intact Canal Wall and Open Cavity Techniques

OBJECTIVE: To evaluate the usefulness of intact bridge mastoidectomy (IBM) and compare its postoperative hearing outcomes and tympanic membrane (TM) graft success rates with those of intact canal wall (ICW) and open cavity (OC) mastoidectomy. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Three hundred twenty-two adult patients who underwent tympano-mastoidectomy for chronic otitis media with or without cholesteatoma. Patients were classified into 3 surgical groups: ICW (n=185), IBM (n=61), and OC (n=76). INTERVENTIONS: Therapeutic surgical interventions include intact canal wall mastoidectomy, intact bridge mastoidectomy, and open cavity mastoidectomy. MAIN OUTCOME MEASURES: Preoperative and postoperative pure-tone averages (PTA), hearing gain, and tympanic membrane (TM) graft success rates. RESULTS: Preoperative PTAs were significantly different among the 3 groups: 42.7±15.9 dB HL (ICW), 54.6±16.0 dB HL (IBM), and 61±26.3 dB HL (OC) (P<0.001). Significant postoperative hearing gain was observed in the ICW (11.1±9.8 dB HL, P<0.001) and IBM (6.1±12.5 dB HL, P<0.001) groups, but not in the OC group (0.1±15.1 dB HL). TM graft success rates were highly stable across all methods (98.4% for ICW, 95.1% for IBM, and 93.4% for OC). These results demonstrate that the hearing outcomes of IBM naturally position themselves exactly between those of ICW and OC. CONCLUSIONS: Intact bridge mastoidectomy (IBM) functions as an effective anatomic and functional middle-ground between ICW and OC. It is a highly useful alternative surgery for difficult cases involving a small antrum, sclerotic mastoid, and intractable infection, as it can successfully eradicate otologic pathologies, restore hearing, and achieve a stable TM graft in a single step.