Bilateral automastoidectomy- A rare case report of destructive sequela with challenges in hearing rehabilitation

Automastoidectomy is a rare sequela of chronic otitismedia characterized by extensive spontaneous erosionof the mastoid and adjacent temporal bone, resulting ina naturally formed canal wall down like cavity.Bilateral automastoidectomy is exceptionallyuncommon. We present a 30 year old female withprogressive bilateral hearing loss for more than fiveyears and a history of recurrent, scanty, mucopurulentotorrhea during childhood. She had no history ofprevious ear surgery or otogenic complications.Otoendoscopy demonstrated bilaterally widenedexternal auditory canals communicating with dry, wellepithelialized mastoid cavities, with tympanicmembrane retraction and evidence of ossicular erosion.Pure tone audiometry revealed severe-to-profoundbilateral conductive hearing loss, with hearingthresholds of 82.5 (decibel) dB in the right ear and68.75 dB in the left ear. High-resolution computedtomography of the temporal bones showed bilateralmastoid cavities with complete loss of mastoid air cells,communication with the posterior external auditorycanals, and near-complete ossicular erosion, producinga characteristic “scooped-out” appearance resembling apostoperative canal wall down mastoid cavity. Thepatient underwent staged bilateral canal wall down mastoidectomy with right type 3c cartilageossiculoplasty and left total ossicular replacementprosthesis ossiculoplasty. Postoperative audiologicalassessment demonstrated approximately 30 dBimprovement in hearing, with stable and drypostoperative cavities. Bilateral hearing aids weresubsequently advised for further auditory rehabilitation.This case highlights the rare occurrence of bilateralautomastoidectomy following long-standing neglectedchronic otitis media and the importance of earlyrecognition and treatment of childhood otorrhea toprevent irreversible temporal bone destruction andhearing loss. Surgical hearing rehabilitation withossicular reconstruction, supplemented by amplificationwhen required, may provide meaningful functionalbenefit in appropriately selected patients.