Comparsion of canal wall up and canal wall down in achieving dry middle ear cavities (Synopsis)

Synopsis on Comparsion of canal wall up and canal wall down in achieving dry middle ear cavities.

Introduction / Background
Canal wall up and canal wall down mastoidectomy represent two surgical approaches to middle ear cleft pathology.1The surgical treatment in the management of the middle ear cholesteatoma has been the matter under debate for years.2,3Various surgical techniques have been adovcated to treat aural cholesteatoma , but the controversy over open or closed procedure for cholesteatoma surgery is still far from resolution.4, 5Beside the eradication of disease and prevention of future cholesteatoma development the surgical procedures for middle ear cholesteatoma are designed to attain some other goals_ to achieve dry ear free from otorrhea and to stabilize or improve hearing.6,7 Canal wall down mastoidectomy is an adequate treatment for chronic otitis media with cholesteatoma and anatomic and functional results are also satisfactory.8It is recomended that wide meatoplasty in canal wall down technique should be done as it ensures a possible one time treatment.9 Variable techniques have been used to achieve dry disease free ear by obliteration of mastoid cavity by using flexible composite sheetsi.e hydroxylapatite and polymer9,periosteal_pericranial flap10,temporalis fascial flap,autogenous11 cranial bone pate.12 In canal wall up technique ,there is more chance of recurrence of the disease b/c cholesteatoma has tendeny to recur if it is not properly eradicated.13studies have shown that mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patient.14 The purpoted significance of this study is to compare the outcome of canal wall up and canal wall down in attaining dry middle ear cavities.Patient will be prevented from life threating complications.The procedure showing beter results then can be applied to the patients in future.
Objectives
The objective of this study is to comapare the efficacy of canal wall up and canal wall down mastoidectomy in achieving dry middle ear cavities.

OPERATIONAL DEFINITION.
Dry middle ear cavity will be determined by aural speculum under microscope.
Canal wall up procedure:
Removal of mastoid ear cells,while retaining the posterior canal wall.
Canal wall down procedure:
Posterior bony meatal wall and the outer attic wall will be removed and the attic , aditus and antrum together with the mastoid antrum and air cell system will be exteriorzed to the external auidatory meatus.

Material and Methods
Hypothesis
More dry middle ear cavities will be achieved by canal wall down mastoidectomy
Study Design : Experimental Study
Sample Size : 30 patients, grup A 15, group B 15 patients
Sampling Method : Purposive( non _probabilty type)
Duration of Study : 1 year after approval of synopsis
Inclusion Criteria
1.Patient with chronic otitis media with granulation tissue and cholesteatroma.
2.Patient with complications of csom.
3.both males and females.
Exclusion Criteria
1.Patient less then 12 years of age.
Patients with bleeding disorders.
Data Collection Procedure
Data will be collected using a proforma (annexed).
Inform consent will be taken
Subjects will be collected from outdoor ENT OPD and will be admitted in ward.
Detail history will be taken.It will include patient id,age ,gender,height,weight,presenting complaint,duration,clinical examination will be done using aural speculum under microscope.Hearing test will be done both pre op and post operatively.
It will include Rennes / weber test,pure toneaudiometery..Patient will be operated under Zeiss microscope .Following procedures will be done.i.e Canal wall up and canal wall down.
Patient will be followed up after every month for 6 months to determine the outcome of the procedure in terms of achieving a dry middle ear cavity.
Statistical Methods
Data will be entered in to spss version 10.0
Descriptive statistics wil be used to calculate mean and standarad deviation for age,gender,height and weight.
Frequency (%) will be calculated for gender findings of microscope,Rennes and weber test,results of puretone audiometrey and post operative examination of dry middle ear cavity uunder microscope.
t- test will be used to compare canal wall up and canal down mastoidectomy results for significance.
chi_square test will be used to compare frequency of dry middle ear cavities.
Difference will be significant if p value is less than 0.5.








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