Diseases of The Middle Ear
A 5 year old boy has been diagnosed to have posterior superior retraction pocket. All would constitute part of the management except: (LQ)
Myringoplasty consists of closing a 'central perforation' in the tympanic membrane in the 'tubotympanic type' or 'safe type' of chronic suppurative otitis mediA. It is not indicated in unsafe or dangerous type of otitis media with posterosuperior atitic perforation.
The patient in question is a case of dangerous or unsafe type of CSOM as Signified by the presence of posterosuperior retraction pocket cholesteatoma.
The mainstay in treatment of this type of CSOM is surgery.
- Primary aim is to remove the disease and render the ear safe.
Secondary aim is to preserve or reconstruct hearing, but never at the cost of the primary aim.
(Mastoid exploration) is the operation of choice.
Tympanoplasty: forms part of secondary aim to reconstruct hearing after a primary mastoid exploration.
- Dangerous type CSOM is associated with a a perforation in attic or posterosuperior region of T.M. along with variable extent of destruction of ossicles and other middle ear contents. Reconstruction of hearing in this type of CSOM thus requires vari- able extent of ossicular reconstruction besides closure of perforation.
Audiometry forms an important step in evaluation of disease process preoperatively.
Although myringoplasty also forms a type of tympanoplasty its use is limited to closure of perforation in the parts tensa of tympanic membrane which is seen in safe type CSOM.