After canal wall-down mastoidectomy for cholesteatoma, a patient presents with a recurrently discharging, moist mastoid cavity 8 months postoperatively. The most common surgical cause of this 'problem cavity' is:

• A Residual cholesteatoma in the epitympanum
• B Inadequate meatoplasty creating poor ventilation and impaired self-cleaning ✓
• C Meningocele through the tegmen defect causing CSF contamination
• D Granulation tissue from exposed bare bone on the facial ridge

Explanation

A 'troublesome' mastoid cavity (persistently wet, infected, not self-cleaning) is most commonly caused by inadequate meatoplasty. The meatoplasty must be large enough to allow ventilation and directional epithelial migration from the external canal to clean the cavity. When too small, the cavity remains moist, hypoxic, and prone to recurrent infection and granulation tissue formation. The definitive revision is an adequate meatoplasty (Korner's or other enlargement procedure). A large, aerated, self-cleaning cavity is the goal of successful open-cavity surgery.

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

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Written and medically reviewed by the StethoPrep medical team.