Clinical Indications for Modified Radical Mastoidectomy

ObjectiveTo establish clinically derived indications for modified radical mastoidectomy in the setting of cholesteatoma.MethodWe 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.ResultsOf 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.ConclusionPosterior 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.