Comparative Study of Postoperative Healing Outcomes With and Without Medicated Cavity Packing Following Canal Wall Down (CWD) Mastoidectomy

Objective The objective of this study was to evaluate the effect of postoperative medicated mastoid cavity packing on healing outcomes following canal wall down (CWD) mastoidectomy compared to no packing. Methods This prospective observational study included 125 patients undergoing CWD mastoidectomy, matched for age and sex, and assigned to two groups. Group A (n=62) received medicated mastoid cavity packing containing ofloxacin, ornidazole, clobetasone propionate, and itraconazole on postoperative days 0, 10, and 20. Group B (n=63) received no postoperative packing. Healing outcomes were evaluated and compared between the groups on postoperative days 45, 75, and 105. A p-value of <0.05 was considered statistically significant. Results The groups were comparable in age and sex distribution. The packed group demonstrated significantly higher rates of complete epithelialization on day 45 (48.4% vs. 15.9%, p < 0.0001) and day 75 (72.6% vs. 49.2%, p = 0.007), with no difference observed by day 105. Graft uptake duration was similar between groups (76.94 days in Group A and 76.19 days in Group B). Granulation tissue, mucosal folds, and otorrhea were more frequent in the non-packed group (25.4%, 6.3%, and 4.8% vs 12.9%, 3.2%, and 3.2%, respectively) during early follow-up, though not statistically significant. Mean epithelialization time was significantly shorter in the packed group (84.0 vs. 92.8 days, p = 0.001). Conclusion Medicated mastoid cavity packing promotes earlier epithelialization following CWD mastoidectomy and is associated with a lower incidence of granulation tissue without affecting graft uptake. It offers particular benefits in low-resource settings by enhancing healing and reducing follow-up needs. Larger studies are warranted to establish standardized postoperative care protocols.