Introduction
Mastoidectomy is one of the most common surgical procedures performed on
the temporal bone1. Its indications include
cholesteatoma, acute mastoiditis, chronic middle ear disease, chronic
tympanic membrane perforations, tumours, and cochlear
implantation2,3. Since the 1950s, the application of
postoperative, mastoid pressure dressings (MPD) became widely accepted
following the first use of temporalis fascia grafts in middle ear
surgery4,5. The procedure for applying a mastoid
pressure dressing consists of a circumferential head bandage overlying
non-stick padded dressings, such as gauze swabs, which are placed over
the pinna, thus applying pressure to the surgical
area6,7. Mastoid pressure dressings are usually kept
in place for 24 hours, replaced after one (1) day, and removed after
three (3) days9,10. The ostensible purpose of this
dressing is to prevent the potential formation of a dead space that may
cause hematoma or seroma formation, which can result in pinna protrusion
or wound breakdown and infection4,6,8.
Mastoid pressure dressings can cause severe discomfort, itching,
headaches, and pressure ulcers. They are less tolerated by children,
especially in hot weather, and are associated with anxiety upon
removal10. In addition, the sight of a child’s head
wrapped in a large mastoid pressure dressing may cause parents to
experience increased stress and concern.
Some prior studies that investigated the efficacy of applying mastoid
pressure dressings following cochlear implantation and middle ear
surgery in adults showed no significant difference in the rate of wound
complications7,14. In fact, other reports revealed an
increase in wound complications among patients upon whom a mastoid
pressure dressing was applied after middle ear
surgery8,13,15. Regardless, the efficacy issue remains
unresolved, with most institutions continuing to apply mastoid pressure
dressings on patients undergoing mastoidectomy, including children. In
fact, no data has been published about pressure dressings applied to
children following mastoidectomy in a contaminated surgical site such as
that found in cholesteatoma and chronic ear disease, and their relation
to postoperative pain. This is likely because a presumption has built up
around this practice that it is intrinsically beneficial.