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SURGERY FOR OTITIS MEDIA WITH CHOLESTEATOMA : CANAL UP VERSUS CANAL DOWN PROCEDURES

Otitis media with cholesteatoma is regarded as nonmalignant destructive ear disease. It was first described in 1829 as a pearly tumor. According to Brown J S (1982), it is a bone eroding skin-lined cavity filled with concentric layers of desquamated epithelium. Because of its eroding character, cholesteatoma has been regarded as an unfavorable pathological disorder in the history of otitis media. Surgery for the cholesteatoma is still a challenge for otologists due to impending extra cranial and intracranial complications. The surgical procedures are aimed at not only for eradication and removal of the disease completely but also to provide a complication free ear for rest of life. Two surgical techniques are considered worldwide for this disease process: i) Open cavity mastoidectomy i.e. canal wall down and ii) Closed cavity mastoidectomy i.e. canal wall up procedure. The choice depends upon the age of patient, extent of disease and the pneumatisation of mastoid bone.