A 57-year-old boy has been diagnosed to have posterior superior retraction pocket cholesteatoma. All would constitute part of the management, except –
Correct Answer: Myringoplasty
Description: Ans-DMyringoplasty consists of closing a 'central perforation' in the tympanic membrane in the 'tubotympanic type' or 'safe type' of chronic suppurative otitis media. It is not indicated in the unsafe or dangerous type of otitis media with posterosuperior attic perforation.The patient in question is a case of the dangerous or unsafe type of CSOM as Signified by the presence of posterosuperior retraction pocket cholesteatoma.The mainstay in the treatment of this type of CSOM is surgery.- The primary aim is to remove the disease and render the ear safe.A secondary aim is to preserve or reconstruct hearing, but never at the cost of the primary aim.(Mastoid exploration) is the operation of choice.Tympanoplasty: forms part of the secondary aim to reconstruct hearing after a primary mastoid exploration.- Dangerous type CSOM is associated with a perforation in the attic or posterosuperior region of T.M. along with the variable extent of destruction of ossicles and other middle ear contents. Reconstruction of hearing in this type of CSOM thus requires the variable extent of ossicular reconstruction besides closure of perforation.Audiometry forms an important step in the evaluation of disease process preoperatively.Although myringoplasty also forms a type of tympanoplasty its use is limited to closure of a perforation in the parts tensa of tympanic membrane which is seen in safe type CSOM.
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