Revision mastoid surgery

Surgery of chronic ear disease once focused on the critical need to preserve life. Today, with advances in antimicrobials accompanied by the development of surgical armanentarium and techniques, the contemporary otologist strives to attain the exacting goals, in order of priority, of elimination of disease, prevention of recurrent disease, and, where possible, restoration of auditory function. Factors that the surgeon cannot control and that mitigate against surgical success include the extent of disease at initial presentation, the presence of anomalies of the eustachian tube and nasopharyngeal vault, and the existence of underlying diseases that impair wound healing and resistance to infection, such as diabetes mellitus, AIDS, and chemotherapeutic immunosuppression. This review focuses on the indications for revision mastoidectomy, ie, those factors that are amenable to amelioration by surgical intervention and which, at the final analysis, reflect the failure of the initial operative procedure to attain surgical goals. Pitfalls, caveats, and techniques the authors have found to be useful in patient management are presented; the indications for planned, second-look procedures and an exhaustive description of surgical technique are not within the scope of this article.