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.