KENT H & RC: Education: CD & DVDs: Mastoid Obliteration using Inferiorly based flap and Conchal cartilage.

Karnataka ENT Hospital & Research Center
Oppsite S.P Office, Kelagote, Chitradurga - 577501, Karnataka, India.
Near Bengalooru (Bangalore), on NH-4 and NH-13.
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Mastoid Obliteration using Inferiorly Based Flap

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Cholesteatoma remains a common otological problem. Otorrhoea following open mastoid cavity (Canal wall down) is surgeries common and is estimated to occur in 10 to 60% of patients (1-6). Various contributing factors for discharging cavity identified are inadequate surgery, residual or recurrent cholesteatoma, high facial ridge, kidney shape of a mastoid cavity, state of the tympanic membrane and the size of the meatus. Even in the ideal cavity, which is small with a low facial ridge and large meatus, 10% discharge recurrently (7). Various techniques designed to promote epithelialization have been proposed including cavity revision with or without a meatoplasty, cavity obliteration by different methods and partial or total reconstruction of the cavity. No single technique has proved superior. Considering patients preferences, financial limitations and cost effectiveness, the optimal treatment for cholesteatoma must be one operation, provided it achieves a dry safe ear. Canal wall down surgery with full cavity obliteration has become surgery of choice for all Chronic suppurative otitis media with cholesteatoma (8). Moreover, the altered acoustic behavior of the open cavity is known to cause partial extensive discrepancies of the resonance-caused sound-pressure augmentation in the frequencies of 3 and 4 kHz, which are important for speech perception. The average difference is reported to be more than 10 dB (SPL). Proved surgical techniques of cavity obliteration and meatoplasty can lead to a nearly normalized acoustic behavior of the outer ear in a statistic significant way (9). Swimming, diving, and free participation in all other aquatic sports are important additional benefits of cavity obliteration techniques (10). Even fitting a canal type hearing aid may pose difficulty in large cavities. Therefore, mastoid obliteraiton is beneficial in Cholesteatoma surgery.

In this educational DVD, Complete procedure of Canal Down Mastoidectomy along with mastoid obliteration using inferiorly based soft tissue flap and conchal cartilage is shown along with appropriate tips and ideas.