A 10 yrs. old boy came to us because of recurring spells of otitis media involving the left ear with chronic discharge which did not stop despite antibiotics over 7 years. Otoscopy did show a very narrow left external auditory canal with total atelectasis of the tympanic membrane and retention of keratin in the epitympanum. Audiometry revealed a surprising minimal conductive deafness of the left ear Fig.1a) with a very reduced compliance on Tympanometry (Fig. 1b). Radiology (HRCT) showed a reduced pneumatization with sclerotic mastoid of the left temporal bone. The left mastoid cells, middle ear and attic were filled with scar and fluid. The scutum was eroded with a sharp cut destruction of the lateral attic wall. The malleus head and incus body were unclearly delineated (Figs. 2a, 2b). The diagnosis was: Left chronic otitis media with secondary acquired cholesteatoma. There was no abnormality of the right temporal bone.
My questions are:
1. Does the left ear needs surgery?
2. If surgery: open or closed cavity?
3. If open cavity: obliteration of the mastoid cavity and if yes how?
4. Myringoplasty: how?
5. Ossiculoplasty: how (one stage two stages)?
6. What result would you predict in regard to: 1. Dry ear 2. Hearing 3. Recurrence of cholesteatoma?
Thank you for your help
The Figures are enclosed as PDF
Fig. 1a PTA - Fig. 1b Tympanometry
Figs. 2a HRCT axial
Fig. 2b HRCT coronal