Jubilee Hospital, Trivandrum.
Chronic Ear disease can be of two types-Tubotympanic disease and Cholesteatoma.
Cholesteatoma destructive ear disease in which squamous epithelium builds up in layers and erodes the bone of the middle ear and mastoid. In its early stages, Cholesteatoma tends to attack the ossicles, the small bones conducting sound from the eardrum to the inner ear. This causes conductive deafness, sometimes with unpleasant smelling discharge, headache and ear pain. If the disease progresses, it can erode the inner ear causing total and permanent deafness and giddiness. If Cholesteatoma erodes into the balance organ kept in the inner ear, vertigo, a severe form of dizziness, results.
Cholesteatoma can also attack the facial nerve causing facial paralysis. In rare cases the disease erodes upwards. The roof of the ear is the floor of the brain. If this thin plate of bone is breached, meningitis, brain abscess and death can result. The Cholesteatoma is made of layers of dead skin, like an onion. Only the outer layer, known as the matrix, contains live growing skin cells. Cholesteatoma is the most serious form of chronic ear infection. It is not a tumor, though it can behave like one. It is not cancer and never spreads widely throughout the body – though it can cause quite enough trouble by its local destructive effects. In most cases, the progress of Cholesteatoma is slow. It can take years or even decades to eat its way slowly through the structures of the ear.
Mastoidectomy is the operation to remove Cholesteatoma. The mastoid is the bone behind the ear. It is part of the temporal bone, which forms the base of the skull and contains all the structures of the ear, as well as the facial nerve and some big blood vessels that go into the brain. The normal mastoid contains a honeycomb arrangement of air cells, which connect with air in the middle ear. The attic, just above the eardrum, is where the middle ear meets the mastoid. The attic contains the head of the malleus and the body of the incus. These two ossicles are very commonly surrounded by Cholesteatoma. To remove Cholesteatoma, we usually need to drill out the mastoid. This gets us behind the disease so we can remove it. The aims of Cholesteatoma surgery are to remove the disease, to prevent future complications such as facial paralysis, total and permanent deafness, dizziness, spread of infection into the brain, to give you a dry ear, that doesn’t keep getting infected and to give you as good hearing possible.
Modified Radical Mastoidectomy (MRM)
A postaural approach is better. Mastoid cavity is created. Entire cholesteatoma sac is removed. A good size meatoplasty is created making the opening to the ear as large as possible, to help with ventilation and cleaning afterwards. A shallow, smooth walled cavity is much easier to keep clean, and there is less risk of Cholesteatoma coming back afterwards.
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