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November 16, 2022Ear Surgery for Cholesteatoma
Cholesteatoma - Canal wall down tympanomastoidectomy. Inside out technique with meatoplasty is a versatile technique for cholesteatoma. It involves following the cholesteatoma from middle ear to antrum and then inside mastoid air cells. At the end, the patient gets a canal wall down cavity for extensive lesions. This also necessitates a meatoplasty. It helps in post operative cleaning of the cavity and avoids wet ear.
One significant advantage of the Inside Out technique is that it allows the creation of a canal wall down cavity for more extensive cholesteatoma lesions. This surgical modification facilitates thorough surveillance and subsequent management of the underlying condition. Furthermore, within this revised cavity, the patient achieves improved accessibility for postoperative cleaning, a crucial aspect of successful cholesteatoma treatment. By employing the meatoplasty procedure, the surgical team ensures optimal exposure and maintenance of the cavity, substantially reducing the likelihood of postoperative oozing or the development of a wet ear phenomenon.
The incorporation of meatoplasty within the Inside Out technique is essential for impeding potential postoperative complications while promoting complete recovery. By reshaping the ear canal and establishing effective cleaning access, infection and subsequent inflammation are minimized. Meatoplasty also offers numerous other benefits, including improved aesthetic outcomes, better egress of aural secretions, and enhanced patient satisfaction. Overall, this combined surgical technique effectively addresses the challenges posed by cholesteatoma, resulting in improved quality of life and reduced chances of recurrence for patients.
Ear surgery for Cholesteatoma treatment with canal wall down (CWD) approach using the inside-out technique is a procedure performed to remove a type of abnormal skin growth, from the middle ear. This technique involves the removal of the posterior and superior canal wall, creating a bony cavity within the ear to prevent the cholesteatoma from recurring. The surgery was performed by Dr Akbar Abbas who is one of the best ENT specialist in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan.
Cholesteatoma is a noncancerous growth that can occur when skin cells accumulate in the middle ear and form a pocket. Over time, it can expand and erode the surrounding bone, causing various complications, including hearing loss, dizziness, recurrent ear infections, and, in severe cases, damage to the facial nerve.
The CWD approach with the inside-out technique is often recommended for cases in which the cholesteatoma is extensive or recurrent. It involves removing the ear canal and creating a larger access to the middle ear, allowing the surgeon to thoroughly remove the abnormal tissue and prevent re-growth.
Ear surgery for Cholesteatoma begins with the patient under general anesthesia or local anesthesia with sedation. An incision is made behind the ear to expose the mastoid bone. The mastoid bone is then drilled to gain access to the middle ear. The posterior and superior ear canal walls are removed to create a larger opening into the middle ear cavity.
Using an operating microscope, the surgeon carefully removes the cholesteatoma and thoroughly cleans the area. If the cholesteatoma has caused damage to the surrounding structures, such as the ossicles or facial nerve, repairs or reconstructive procedures may be performed at this stage.
After removing the abnormal tissue, the surgeon reconstructs the middle ear with the help of various materials, such as synthetic grafts, cartilage, or biological materials. The aim is to reconstruct the hearing mechanism and prevent the recurrence of cholesteatoma. The surgical site is then closed, and dressings are applied.
Postoperatively, patients usually require regular check-ups to monitor healing and to remove any accumulated debris or fluids. Patients are advised to avoid water entry into their ears, follow the prescribed medication regimen, and maintain good ear hygiene.
While this technique has proven effective in removing cholesteatoma and reducing the risk of recurrence, it is important to note that there are potential risks and complications associated with any surgical procedure. These may include infection, hearing loss, dizziness or vertigo, taste disturbance, facial nerve weakness, and rare instances of cerebrospinal fluid leakage.
In conclusion, ear surgery for cholesteatoma with a canal wall down, inside-out technique is a surgical procedure aimed at removing cholesteatoma and preventing its recurrence. It involves the removal of the posterior and superior canal walls, thorough cleaning of the middle ear cavity, and reconstruction of the hearing mechanism. This technique offers a comprehensive approach to managing cholesteatoma and improving the patient’s overall ear health.
This is an educational video for students and patients for making informed decisions about their own and others health. The surgery was performed by Dr Akbar Abbas who is one of the best ENT specialist in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University Hospital.
