Ans. a (Facial). (Ref. Disease of ENT by PL Dhingra, 2nd/pg.384)SURGERIES FOR CHOLESTEATOMA# Closed or canal wall up mastoidectomy (preferred for uncomplicated cholesteatoma)- Cortical mastoidectomy- Combined approach tympanoplasty- Intact canal wall tympanoplasty with mastoidectomy# Open or canal wall down mastoidectomy (preferred for complicated cholesteatoma e.g. with lateral sinus thrombosis)- Atticotomy- Radical mastoidectomy- Modified Radical MastoidectomyOverview of Surgical Procedures for Cholesteatoma.1ProcedureEnd ResultAdvantages after SurgeryDisadvantages after Surgery2Tympanoplasty (canal wall up) with mastoidectomyEar canal with tympanic membraneLow risk of otorrheaRisk of recurrent pars flaccida cholesteatoma3AtticotomyEar canal with tympanic membrane and defect into epitympanumIntermediate risk of otorrheaRisk of recurrent pars flaccida cholesteatoma4Modified radical mastoidectomy (canal wall down)Mastoid cavity with tympanic membraneLow chance of recurrent pars flaccida cholesteatomaSignificant risk of otorrhea5Radical mastoidectomy (canal wall down)Mastoid cavity without tympanic membraneLow chance of recurrent pars flaccida and pars tensa cholesteatomaSignificant risk of otorrhea and poor hearingIn radical mastoidectomy middle ear, attic, antrum and mastoid are converted into a single cavity by removing posterior meatal wall, remnants of tympanic membrane, ossicles (except foot plate of stapes) and mucoperiosteal linings. Indications:# Cholesteatoma# Petrous apex infection# Glomus# Carcinoma middle earComplications# Facial palsy# Perichondritis of pinna# Injury to dura or sigmoid sinus# Labyrinthitis# Severe conductive deafness# Non-healing cavity