AIPG 2003 ENT Myringoplasty

Question.
69. A 5-year-old boy has been diagnosed to have posterior superior retraction pocket cholesteatoma. All would constitute part of the management, except:
1. Audiometry.
2. Mastoid exploration.
3. Tympanoplasty.
4. Myringoplasty.
Answer
4. Myringoplasty.
Reference
Logan Turner Page 289
Fundamentals of Ear, Nose, Throat and Head and Neck Surgery - S.K.De - 7th Edition Page 123
Diseases of Ear, Nose and Throat. – P.L.Dhingra - 2nd Edition Pages 35,75
Quality
Reader
Status
Repeat
QTDF
De
Discussion
Ear Perforations can be regarded as safe if they are central perforations or Tubotympanic type and unsafe if they are of attico antral type or associated with cholesteotoma. This boy in our Question has “Unsafe” type of CSOM. The objectives of the surgical management will be to
1. To remove the disease focus
2. To reconstruct the ear as far as possible, but not at the cost of objective 1.
The management of such cases would consist of
1. Evaluation – Radiological and Audiometry
2. Atticotomy
3. Modified Radical mastoidectomy
4. Tympanoplasty
Explanation
1. Audiometry is needed for medicolegal purposes as we are doing a destructive or quasidestructive surgical procedure and we want to document that the patient already had a hearing loss as a consequence of the disease
2. Mastoid exploration is an essential part of management.
3. Tympanoplasty is done for reconstruction.
4. Myringoplasty is not done in cases of Unsafe Ear. It is done only in cases of Safe ear
Comments
Let us see the types of tympanoplasty

Type	Defect	Procedure
I	Central perforation	Repaired with a graft. Also called as Myringoplasty
II	Perforation of TM with Erosion of Malleus	Graft is placed on Incus or remnant of Malleus
III	Perforation of TM with Absence of Malleus and Incus	Graft is placed directly on head of Stapes
IV	Only Foot plate of Stapes is present	Graft is placed in Foot plate of Stapes And round window is separated
V	Foot plate of Stapes is fixed. And Round window is functioning	Another window is created in the horizontal canal Also called as Fenestration Operation

Tips
Myringoplasty is done is safe ear or tubotympanic type or central perforation