Clinical Indications for Modified Radical Mastoidectomy

Abstract

Objective: To establish clinically derived indications for modified radical mastoidectomy in the setting of cholesteatoma. Method: We performed a retrospective review of 223 patients who underwent 265 operations for cholesteatoma in a single tertiary pediatric otolaryngology practice. Clinical characteristics of patients who underwent modified radical mastoidectomy were compared to those who underwent simple mastoidectomy or atticotomy. Results: Of the 265 procedures, 10% were modified radical mastoidectomy. Congenital cholesteatoma was more common in the the canal-wall-up group, while recurrent cholesteatoma was more common in those who had a canal-wall-down procedure. The Mills score for those who had a modified radical mastoidectomy was significantly higher than those who underwent canal-wall-up procedures (4.9 vs 3.2, P < .05). Furthermore, extremely poorly pneumatized mastoids and facial nerve dehiscence were both more common in the group who underwent modified radical mastoidectomy. Conclusion: Posterior wall preservation or reconstruction is possible in the large majority of cases. Severity of Mills score correlated well with the need for a canal-wall-down procedure. This was further reflected by the fact that this group had a higher incidence of facial nerve dehiscence due to cholesteatoma.