Publication:

Chronic otitis media with cholesteatoma: clinical presentation and surgical management

Background Cholesteatoma has long been a formidable adversary to the otologic surgeon. There is no single surgical treatment of choice for aural cholesteatoma. The extent of cholesteatoma, the amount of preoperative destruction, and mastoid pneumatization, guides the surgeon in choosing the type of operation for a particular ear. Intra-operative findings guide the surgeon to perform the required surgery despite thorough pre-operative work-up.

Methods Prospective study on 42 patients who underwent surgery for cholesteatoma.

Results Cholesteatoma most commonly affected males aged between 10-20 years. Also, the disease was noted to be more aggressive in the paediatric age group. Foul smelling ear discharge was the most common presenting symptom followed by hearing loss. 21% of patients presented with complications. Canal wall down mastoidectomy was done in patients with complications and in cases where adequate disease clearance could not be accomplished with the posterior canal wall intact. All patients in the study underwent ossicular reconstruction. This was owing to either the destruction of ossicles by the disease process or to achieve adequate disease clearance.

Conclusions Disease eradication is still the main aim of the surgery, but, when it can be achieved keeping the posterior canal wall intact, the canal wall should always be left intact. With advances in technology and availability of angled endoscopes this should be given more consideration. However, in a patient with complications and patients who are not available for regular follow-up the canal wall down surgery is preferred.