Professional Documents
Culture Documents
Investigations
1.Examination under microscope 2.Tuning fork tests and audiogram 3.X-ray and ct scan temporal bone 4.Culture and sensitivity of discharge
Surgical Treatment
Canal Wall down:
Attico-antrostomy
Modified Radical Mastoidectomy (MRM) Radical Mastoidectomy Canal Wall up: Combined Approach through the meatus and mastoid
Medical Treatment
Topical ear drops + frequent suction clearance Indications: 1. Early disease with shallow retraction pocket 2.Elderly patients 3.Pts who are not fit for surgery under G.A. 4.Pts who can regularly come for follow up
The treatment of choice is surgical only. Surgery is done even in a wet ear unlike safe csom
Canal wall up
Canal wall down Meatus-widely open Doctor dependant cleaning twice a year Low rate of reccurence Second look surgery not required Swimming not allowed Problems in using hearing aid due to large meatus
Attico-antrostomy
Cortical Mastoidectomy
Boundaries of cavity
Superior: Dural or Tegmen plate Anterior: Posterior wall of external auditory canal Inferior: Digastric ridge Posterior: Sigmoid sinus plate
Cortical Mastoidectomy
1. mastoiditis 2. CSOM , active refractory to antibiotics 3. Secretory otitis media refractory to antibiotics
Antiseptic dressing
Draping
Marking of incision
Widening of aditus
Aditus widened
Mastoid dressing
It is a modification of radical mastoidectomy where much of the hearing mechanism as possible is preserved
Pre-operative Anatomy
Surgical Steps
Widening of aditus
Healed Concho-meatoplasty
Radical Mastoidectomy
Radical Mastoidectomy
Surgical Steps
Indications
1. CSOM attico-antral disease with Intra-cranial complication Recurrence after modified radical mastoidectomy 2. Limited malignancy of middle ear 3. Osteomyelitis of temporal bone
Reconstructive surgery
Hearing can be restored by myringoplasty or tympanoplasty
Tympanoplasty
Thank You