HSC Section 8_April 2017

TABLE I. Audiometric Outcomes for CWU Patients Who Underwent Either Second Look or No Second-Look Operative Strategy.

Mean (CI 95%)

No Second Look

Second Look

P Value*

21.2 (16.8–25.6) 85.0 (77.9–92.0) 21.7 (17.1–26.2) 83.2 (75.2–91.3) 23.7 (18.3–29.1) 85.8 (77.1–94.5)

26.4 (22.8–30.1) 92.8 (86.5–99.1) 27.0 (23.2–30.8) 91.0 (84.2–97.9) 28.2 (23.7–32.7) 90.5 (83.7–97.2)

Preoperative air bone gap

0.07

Preoperative WRS

0.10

Postoperative air bone gap

0.08 0.14

Postoperative WRS

Most recent air bone gap

0.21

Most recent WRS

0.40 0.60

2 4.58 ( 2 12.2–3.07) 2 2.48 ( 2 8.87–3.91) 2 2.86 ( 2 10.89–5.17)

2 1.87 ( 2 8.71–4.98) 2 1.27 ( 2 6.61–4.08) 2 3.16( 2 9.77–3.45)

WRS change preoperative to postoperative

WRS change postoperative latest

0.77

WRS change preoperative latest

0.95

*One-way ANOVA. Two-tailed. ANOVA 5 analysis of variance; CI 5 confidence interval; CWU 5 canal wall-up procedures; WRS 5 word recognition score.

cholesteatoma when taken to the operating room, and none had residual cholesteatoma. There were three (3.8%) CWU patients who had a complication following their first tympanoplasty- mastoidectomy, including postoperative nausea and vom- iting requiring admission, a tegmen defect with cerebro- spinal fluid leak, and a surgical site infection. For CWU patients undergoing a second-look procedure, two (4.3%) patients experienced a complication including encephalo- cele and a wound seroma. For the purposes of assessing the audiology outcomes, CWU patients were grouped into second-look and no second-look cohorts. When examining WRSs and ABGs at pre-, immediate postoperative, and the latest follow-up vis- its, there were no significant differences observed (Table I) ( P > 0.05 for all variable pairs). In all CWU patients, no OCR was completed in 42 (52.5%) patients. Seven (8.8%) patients had OCR at a planned single-stage procedure and 31 (38.8%) at a planned second-look procedure. The pre- and posttreatment air conduction pure tone average and

WRS results for all CWU patients are reported in supple- mental figures (Figs. 1 and 2, respectively). Charges and costs for the components of care were tabulated (Table II). The most expensive charge component was the surgical procedure, followed by the CT scan of the temporal bones. A cost analysis demonstrated that patients with a second-look strategy had a significantly higher number of postoperative visits compared to patients with no second look (10.4 visits vs. 6.32; P 5 0.0007) (Table III). There was no significant difference in follow-up period, temporal bone CTs, and audiology clinic visits (each P > 0.05). Canal wall-up procedures patients with a second-look management strategy had a significantly higher cost of care versus patients with no second-look strategy (USD mean of $41,411 vs. $23,529; P < 0.0001).

DISCUSSION The primary goal of cholesteatoma surgical manage- ment is to produce a safe ear, with a secondary goal to

Fig. 1. Pretreatment pure tone average and word recognition score scattergram.

Fig. 2. Posttreatment pure tone average and word recognition score scattergram.

Crowson et al.: Second-Look Tympanoplasty-Mastoidectomy

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