English

Abstract

INTRODUCTION: The surgical treatment of cholesteatoma in paediatric age group has changed opinion many times in the evolution of cholesteatoma surgery. Intact canal wall technique allows provision for maintaining the depth of the middle ear and postoperative hearing is much better than in canal wall down procedure. Canal wall down method precludes regular cleaning of the large cavity left behind. In CWU method incidence of recurrent and residual CH are more than in CWD methods. It is more common because inspection of epi-tympanum and medial aspects of the ossicles is not possible in ICW procedures. As a result, the disease recurs within 6 to 12 months. MATERIALS AND METHODS: Fifty children attending the OPD of Government General Hospital Kurnool with CH, confirmed with CT scan are taken and subjected to ICW tympano-mastoidectomy with or without ossiculoplasty. They are followed for a period of 18 months for residual disease,auditory evaluation and otoscopic examination for graft take up. RESULTS: There was improvement in hearing in 78% of the patients. Graft healing was good in 80.85% of cases. Recurrence was seen in 19.15% of patients. 14% of the patients ICW had to be converted to a CWD procedure within 8 months. There were no reports of intra cranial complication in this series. CONCLUSION: ICW procedure in paediatric cholesteatoma gives better results if the disease is limited to the posterior mesotympanum and not beyond the auditus. Uneventful 18months follow up period was seen in 80.85% of the patients. Recurrent disease is less common if the mastoids are less pneumatized. Revision to CWD may be required in early recurrence; in this series it was 14% of the patients.