A 24-year-old man has a small attic cholesteatoma confined to the epitympanum. Intraoperative assessment shows the ossicular chain fully intact and mobile, the middle ear mucosa healthy, and the preoperative air-bone gap only 15 dB with good bone conduction. Which operative procedure is most appropriate?
- A Bondy modified radical mastoidectomy leaving the ossicular chain untouched ✓
- B Radical mastoidectomy with exteriorization of all middle ear spaces
- C Canal wall down mastoidectomy with removal of the incus and head of malleus
- D Cortical mastoidectomy through the cortex without opening the aditus
Correct answer: A. Bondy modified radical mastoidectomy leaving the ossicular chain untouched
Explanation
The Bondy operation creates an open mastoid cavity for disease exteriorization but deliberately leaves an intact ossicular chain and tympanic membrane undisturbed, preserving the patient's good hearing. It suits cholesteatoma limited to the attic and antrum with a healthy, uninvolved middle ear. B radical mastoidectomy removes the ossicles and converts the middle ear into part of the cavity, sacrificing hearing unnecessarily here.
Reference: Scott-Brown's Essential Otorhinolaryngology, 2nd ed.
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Written and medically reviewed by the StethoPrep medical team.