Deciding Between MRM or CWI Mastoidectomy: My Situation
Age: 22 Gender: Male Height: 180 cm Weight: 64 kg Ethnicity: Indian Duration of Symptoms: 5 years Location: India I am sharing my HRCT findings related to the temporal bone: - There is a non-dependent soft tissue density present in the mesotympanum. - There is rarefaction observed on the long process of the incus, as well as on the stapes. - The scutum shows blunting which extends into the mastoid air cells through the aditus ad antrum. - There is thinning noticeable in the tegmen tympani. - The left cochlea and semicircular canals appear to be normal. - The left bony canals of the facial nerve are within normal limits. - The left sinodural plate is intact. - The left parotid gland appears to be functioning normally. - Hyper-pneumatization of the mastoid air cells is evident. IMPRESSION: The HRCT examination of the temporal region indicates: left unsafe chronic suppurative otitis media (CSOM) with cholesteatoma. Regarding my condition of unsafe CSOM accompanied by a cholesteatoma, I am seeking clarification on the surgical options available. Specifically, will I be undergoing a mastoid radical mastoidectomy (MRM) or a canal wall down mastoidectomy (CWI)? Will the canal wall be excised or maintained during the procedure? Furthermore, I would like to know what precautions I should take post-operation and for what duration. I have been informed that there is a significant wait time for elective surgeries at my hospital due to the high number of patients. Is it advisable to delay the surgery, or should I proceed more urgently? Any guidance on this matter would be greatly appreciated.
Answers (1)
7/10/2025, 4:10:44 PM
OpenHealth AI
Thank you for sharing detailed information about your condition. Based on your HRCT findings, it appears you have left unsafe chronic suppurative otitis media (CSOM) with cholesteatoma—a situation that often requires surgical intervention. Here’s a structured response to your concerns:
Main Points
- Surgical Options: Both radical mastoidectomy (MRM) and canal wall down mastoidectomy (CWI) may be considered depending on the extent of damage and surgeon preferences.
- Post-Operation Care: Careful post-operative precautions are crucial for recovery.
- Timing of Surgery: Delaying the surgery may lead to complications, so it’s wise to proceed unless advised otherwise.
Explanation
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Surgical Options:
- Radical Mastoidectomy (MRM): This typically involves removing the affected tissue and surrounding structures, including the mastoid air cells and possibly the canal wall.
- Canal Wall Down Mastoidectomy (CWI): This retains the canal wall but also removes parts of the mastoid to manage the cholesteatoma effectively. The decision on which option is suitable for you will largely depend on the extent of your cholesteatoma and the surgeon’s plan to ensure complete removal while preserving your hearing as much as possible.
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Post-Operation Care:
- Immediate Care: Follow your surgeon's instructions regarding wound care to prevent infections. Expect some drainage; keep the surgical area dry.
- Avoid Water Exposure: Refrain from getting water in your ear for several weeks to avoid complications.
- Regular Follow-up: Schedule follow-up appointments to monitor your healing and ensure there are no complications.
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Timing of Surgery:
- Given the nature of your condition and symptoms persisting for five years, it’s advisable to proceed with the surgery sooner rather than later. Delaying the procedure could lead to further damage, increased infection risk, or complications like hearing loss.
Next Steps
- Consult Your Surgeon: Discuss the surgical approach best suited for your specific case, ensuring you understand whether the canal wall will be excised or preserved.
- Prepare for Surgery: Ensure that you understand the pre-operative instructions and arrange for post-operative support.
- Keep Track of Symptoms: Monitor any changes in your symptoms while you await surgery, and communicate these to your healthcare provider.
Feel free to ask if you have more questions, and I wish you a smooth journey ahead in managing your health!
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