A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
First, I remember that attic cholesteatoma is a type of middle ear cholesteatoma that affects the attic area. It's a destructive process, so surgery is usually needed to remove it and prevent complications. Lateral sinus thrombophlebitis is a serious complication, often called "Pouillot's abscess," which occurs when infection spreads to the lateral sinus, leading to thrombosis and inflammation. This is a medical emergency because it can lead to sepsis or meningitis.
The options were A, B, C, D, but since they're not listed here, I need to think about the standard procedures for this condition. The main surgical options for cholesteatoma are tympanoplasty with mastoidectomy. Depending on the extent, it could be a simple or radical procedure. However, in the presence of lateral sinus thrombophlebitis, the approach might be different.
Wait, lateral sinus thrombophlebitis is a complication of acute otitis media or cholesteatoma. The treatment would involve managing the infection first, maybe with antibiotics, but surgery is also necessary. The operation might need to address both the cholesteatoma and the infected sinus.
I think the procedure here is a modified radical mastoidectomy. This involves removing the infected tissue, the cholesteatoma, and possibly part of the lateral sinus if it's affected. The lateral sinus might need to be coagulated or excised if it's thrombosed. So the operation would be a modified radical mastoidectomy to remove the cholesteatoma and manage the lateral sinus involvement.
Other options might include simple mastoidectomy, but that's for less severe cases. Radical mastoidectomy removes more structures, but modified radical preserves the ossicles if possible. Since the patient has a cholesteatoma and lateral sinus issue, modified radical is the way to go. The lateral sinus might need to be addressed during the surgery, possibly coagulating the thrombosed part to prevent further infection spread.
So the correct answer should be modified radical mastoidectomy. Let me verify: yes, in cases with lateral sinus thrombophlebitis, modified radical mastoidectomy is the procedure of choice to remove the cholesteatoma and manage the sinus. Other options like simple mastoidectomy wouldn't address the lateral sinus issue adequately. Radical mastoidectomy might be too extensive, but modified radical is more appropriate here.
**Core Concept**
Attic cholesteatoma is a destructive benign lesion of the middle ear that can progress to lateral sinus thrombophlebitis, a life-threatening complication requiring urgent surgical intervention. The procedure must address both cholesteatoma removal and management of the infected lateral sinus.
**Why the Correct Answer is Right**
The operation of choice is **modified radical mastoidectomy**, which involves complete removal of the cholesteatoma, mastoidectomy, and coagulation or excision of the thrombosed lateral sinus. This approach ensures eradication of the cholesteatoma, drainage of infection, and prevention of sepsis or meningitis. The lateral sinus is often