A 35-year-old presents with painless otorrhea and a posterior superior marginal perforation. CT temporal bone shows erosion of the scutum (lateral attic wall) and the ossicular chain is destroyed at the incus body. The ideal surgical approach would be:

• A Canal wall down mastoidectomy (modified radical mastoidectomy) followed by staged ossiculoplasty
• B Intact canal wall mastoidectomy (combined approach tympanoplasty) with reconstruction of incus using cartilage or TORP ✓
• C Simple cortical mastoidectomy (Schwartze's operation) alone
• D Radical mastoidectomy (Bondy's operation) without hearing reconstruction

Explanation

Intact canal wall mastoidectomy (ICWM / combined approach tympanoplasty) is preferred for cholesteatoma with ossicular erosion limited to the incus body when the disease is limited and surgeon expertise allows, as it preserves the posterior canal wall and hearing mechanics. However, the choice depends on extent of disease, mastoid aeration, and risk of residual cholesteatoma. Canal wall down (CWD) is reserved for extensive disease, sclerotic mastoid, recurrent cholesteatoma, or the only hearing ear. Bondy's operation preserves the ossicular chain where disease is confined to the attic above the ossicles.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.