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     It is a case of attico-antral type of CSOM.

INVESTIGATION:

  1. EXAMINATION UNDER MICROSCOPE: It reveals-
  • Presence of cholesteatoma- site & extents.
  • Evidence of bone destruction.
  • Granuloma.
  • Condition of ossicles.
  • Pockets of discharge.
  1. TUNNING FORK TEST AUDIOGRAM: For-
  • Pre- operative assessment.
  • Confirmation the degree & type of hearing loss (conductive or mixed).
  1. CULTURE SENSITIVITY OF EAR DISCHARGE: To select proper antibiotic for local or systemic use.
  2. RIGID OTO-ENDOSCOPY: To see facial recess & sinus tympani.
  3. IMAGING:
  • X-RAY mastoid (schuller & law’s view)- To see- bony erosion, anatomy of mastoid, cholesteatoma (cotton wool appearance).
  • CT-SCAN- To see-

                        a) Blunting of scutum,

                        b) Erosion & destruction of lateral attic wall,

                        c) Widening of aditus,

                        d) displacement & destruction of ossicle,

                        e) Labyrinthine fistula formation,

                        f) Erosion into facial canal, post roof of EAC,

                        g) Dehiscence of Tegmen Tympani & sinus plate,

                        h) Destruction of mastoid or natural mastoidectomy.

  • MRI- Provide complimentary information by allowing characterization of soft tissue masses.

 

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