Narmada, A (2022) Comparative study between Microscopic Modified Radical Mastoidectomy and Endoscopic Mastoidectomy in the Management of Cholesteatoma. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Cholesteatoma is a benign keratinizing epithelial lined cystic structure found in the middle ear and mastoid. Management of patients with cholesteatoma is done by canal wall up and canal wall down techniques of which canal wall down is the most preferred. Canal wall down /Modified radical mastoidectomy is a surgical procedure which involves eradication of the disease, exenteration of diseased and all the accessible mastoid air cells with exterioristion of the mastoid by making mastoid and middle ear as a single cavity. Conventionally it is done using a microscope. With the advent of endoscopes and the advantages it offers like providing a wider, clearer view of the working field, better visualization of inaccessible areas thereby leading to reduced disruption of normal anatomy and a more complete clearance makes it more acceptable. This study compares microscopic and endoscopic methods in different aspects in the treatment of patients with cholesteatoma. AIM OF THE STUDY: To compare the outcomes of microscopic modified radical mastoidectomy and endoscopic mastoidectomy in patients with cholesteatoma. OBJECTIVES: To compare - hearing improvement, - Preservation of anatomical structures like facial nerve, - postoperative pain, - healing time, - operating time, - complete clearance of disease process. between microscopic and endoscopic mastoidectomies in patients with cholesteatoma. MATERIALS AND METHODS: 40 Patients attending OPD in the Department of ENT and head and neck surgery, Govt stanley medical college and hospital with CSOM (active squamosal disease-cholesteatoma) between november 2020 and october 2021 were selected based on inclusion and exclusion criteria. Thorough audiological evaluation was carried out preoperatively which included otoscopic examination, pure tone audiometry, HRCT temporal bone. All patients had dry ear. All of them underwent rt-PCR for covid-19. After getting consent for general anaesthesia and surgery, 20 patients were subjected to microscopic approach and 20 patients to endoscopic approach of mastoidectomy using 0°nasal endoscope and 30°endoscope. Preoperatively antibiotics were given along with T.Atenolol 25 mg, T.Alprazolam 0.5 mg. Post operatively antibiotics were given for 3 weeks with antihistamines. Post operatively the patients of both the groups were followed up at intervals of 1, 3 and 6months for otoscopic examination, endoscopic examination and pure tone audiometry. INCLUSION CRITERIA: • Age > 18 years. • Presence of chronic otitis media with cholesteatoma (active squamosal type). EXCLUSION CRITERIA: • Cases of revision mastoidectomies. • Patients not willing to give consent for the study. • Terminally ill patients. METHODOLOGY : PREOPERATIVE PREPARATION : Parts prepared. Preoperative instructions given.Vitals checked. Intravenous antibiotics were given. T. Atenolol 25mg and T. Alprax 0.5mg were given the night before surgery. CONCLUSION: Canal wall down mastoidectomy by endoscopy facilitates better visualisation of anatomical structures preventing undue injury to critical structure like facial nerve, semicircular canal etc. It shows wide view of the hidden areas like sinus tympani, facial recess thereby aiding in complete removal of the disease and preventing residual or recurrent cholesteatoma. Endoscopic method reduces the morbidity of the patient post operatively by reducing the pain, complications thereby the healing time. Though it has limitations like single handedness, increased learning curve, limited freedom of instruments in the operating field, it has more benefits than limitations by reduced morbidity postoperatively.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221914055 |
| Uncontrolled Keywords: | Microscopic Modified Radical Mastoidectomy, Endoscopic Mastoidectomy, Management, Cholesteatoma. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 May 2021 10:12 |
| Last Modified: | 17 Dec 2023 08:21 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15757 |
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