Materials and Methods
This study was based on a review of the tertiary center charts of childhood-aged patients who, between 2010 and 2020, underwent mastoidectomy surgery. All cases were performed by senior, experienced surgeons at tertiary healthcare campus (A.G. or M.C.V.). From these medical records, we collected data regarding demographics (age and gender), diagnose, physical examinations, treatments, complications, and VAS scores for acute pain obtained during the postoperative stays.
We analysed the data according to two (2) groups: children who received a mastoid pressure dressing for 24-hours postoperatively and children who did not receive any pressure dressing (where their wounds were only covered). Eligible patients for the study were children under age 18 who underwent mastoidectomy surgery for inflammatory etiology at our institution between 2010 and 2019. Exclusion criteria included: (1) bleeding disorders; (2) mastoid pressure dressing removed less than 24-hours postoperatively; (3) endaural approach mastoidectomy (4) mastoidectomy with non-inflammatory indications, such as cochlear implantation; and (5) lack of follow-up.
Complications were classified as major or minor, as described in previous studies16,17. Minor complications were defined as adverse events that were managed by medical measures, conservative treatment, or minor surgical procedures. Examples are surgical site infection (SSI), dehiscence, and seroma aspiration. Major complications included adverse events that required major surgical procedures; intracranial complications, such as meningitis; or a permanent disability, such as persistent facial paralysis.
All operations were performed with the patient under hypotensive general anesthesia and all ears were locally infiltrated, post aurally and inside the meatus with 1:200,000 adrenaline. Standardized operative techniques were used for all cases. Hemostasis was achieved using bipolar diathermy at a setting of 12 W. Wound closure in the non-mastoid pressure dressing (NMPD) group was achieved with interrupted subcutaneous sutures, interrupted or continuous skin sutures, and 1.5 cm Steri-Strip® applied along the line of the incision, covered by Steripad (Figure 1 ), while in the mastoid pressure dressing (MPD) group subcutaneous sutures were followed with tissue adhesives for skin closure and Steri-Strip®application.
The MPD is composed of a circumferential head bandage with several gauze pads (6 x 6 cm) and cotton wool over the pinna and the mastoid. A ribbon gauze is tied over the eyebrow to keep the bandage in place (Figure 2 ). The surgical incision was evaluated at discharge and at the first postoperative appointment, two to four weeks after surgery. For all patients, routine prophylactic, postoperative antibiotic treatment was administered systemically for seven days and locally, via eardrops, for two weeks.