Publication:

Functional and anatomical results of inside out approach for cholesteatoma surgery

Background The objective of the study was to study the efficacy of inside-out approach in completely eradicating the cholesteatoma from middle ear and mastoid, preservation of hearing and quality of life post mastoidectomy with regards to recurrent discharge, wax, granulations.

Methods Non-randomizedprospective observational study performed at the Department of ENT in Bombay hospital Mumbai. The study involved 40 patients presenting with chronic suppurative otitis media with cholesteatoma. All of them underwent inside out mastoidectomy and were followed up till the end of the study to evaluate the efficacy of inside out mastoidectomy in eradicating the disease from the middle ear cleft, to assess preservation of hearing and to assess cavity problems.

Results Of the 40 patients, 39 patients had a total clearance of disease by the inside out approach, and in 1 patient, we were doubtful of the clearance. All patients came for regular follow up and none of them had residual disease at the end of the study period. Thus, the overall success rate was 100% in this study. A significant improvement in the mean air conduction (p<0.01) and the mean air bone gap (p<0.01) postoperatively was seen in all in the postoperative 3rd month PTA. Only one patient had increased conductive hearing loss one and a half years postoperatively after initial improvement. A dry self-cleansing cavity was achieved in 95% of the patients and only 5% required regular cleaning of waxes the cavities.

Conclusions Inside out mastoidectomy is a better alternative in canal wall down procedures as it not only clears the disease from the middle ear cleft, but also leaves behind a small postoperative cavity, which will preserve the hearing, decrease the cavity problems and increase the quality of life of such patients.