A 34-year-old man undergoes canal wall down mastoidectomy for extensive cholesteatoma. Post-operatively, he is found to have a moist cavity with granulations at 6 months. The most appropriate next step in management is:
- A Cavity obliteration using musculoperiosteal flap and conchal cartilage ✓
- B Observation and regular aural toileting
- C Systemic antifungal therapy
- D Repeat canal wall down surgery with wider meatoplasty
Correct answer: A. Cavity obliteration using musculoperiosteal flap and conchal cartilage
Explanation
A problematic, wet, granulating mastoid cavity after canal wall down mastoidectomy is best managed by cavity obliteration, which reduces the cavity volume and promotes re-epithelialization. Musculoperiosteal flaps (e.g., Palva flap) combined with cartilage obliterate the dead space. Simple observation perpetuates the problem; antifungals are not first-line; wider meatoplasty alone does not address the underlying cavity problem.
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.