A 5-year-old boy been diagnosed to have posterior superior retraction pocket cholesteatoma. All would be included as a part of management, EXCEPT:
1.Audiomertry
2.Mastoid exploration
3.Tympanoplasty
4.Myringoplasty
sol:
Myringoplasty
a. Chronic suppurative otitis may lead to complications such as osteomyelitis of the temporal bone, cerebritis and brain abscess formation, bone destruction, transverse or sigmoid sinus thrombosis, and even death. Long-term complications include petrous apicitis (Gradenigo’s syndrome), tympanosclerosis, and the formation of granuloma or cholesteatoma.
b. Radiographically, there may be mucosal thickening and occasionally fluid levels; both can be readily appreciated on CT. Focal mass lesions can represent granuloma, granulation tissue, and/or cholesteatoma. All of these soft-tissue masses in the middle ear can also produce labyrinthine and ossicular destruction. Destruction of air cells can be followed by fibrous or bony sclerosis, or tympanosclerosis.
c. With chronic otitis, there is often thickening and retraction of the tympanic membrane.
d. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CT scans (3-D x-rays) of the mastoid may be necessary
e. Myringoplasty, which consist of closing of central perforation in tympanic membrane, is indicated in “Safe” type of CSOM.