Modified radical mastoidectomy: a relook at the surgical pitfalls

The primary aim of surgery for cholesteatoma is to eliminate the disease, to produce a safe and dry ear which is self cleansing, modify the anatomy of the tympanomastoid compartment so as to prevent recurrent disease and wherever possible to reconstruct the hearing mechanism. The advances in medical technology and the medical expertise gained over a period of time have greatly influenced the results in cholesteatoma surgery. The aim of the present study was to assess the intraoperative findings during revision mastoid surgery for atticoantral disease and to ascertain the preventable factor that could reduce recurrence. A retrospective analysis of all clinical data and operative notes of patients who had undergone revision surgery for recurrent cholesteatoma, in our unit in a tertiary care centre in south India over a period of 3 years from July 2007 to July 2010 was done. 33 patients had undergone revision mastoid surgery for cholesteatoma. Most patients presented with symptoms and sign of disease about 2 years after the first surgery. The commonest complaint was recurrent foul smelling ear discharge. The most frequent site of recurrent cholesteatoma was the tip cells (72%) and the most important cause for failure of surgery with recurrence of disease was inadequate meatoplasty (70%). In our study, recurrent disease was likely due to cholesteatoma in the tip cells left uncleared and inadequate meatoplasty. Both these issues reflect faulty techniques in performing good meatoplasty or the tip cell are not adequately reduced into the external auditory canal. Bone work is generally taught well in all temporal bone workshops but no emphasis is laid on soft tissue work hence the failure and recurrence. Thus we emphasize the need to teach the budding otologists the importance of and proper technique of meatoplasty.