Comparison of “Inside-out Technique” and “Outside-in Technique” of Canal Wall-down Mastoidectomy in Cholesteatoma

Abstract Aim: The objective of the study is to compare the “outside-in” and “inside-out” approach in cholesteatoma eradication from the middle ear and mastoid cavity. Hearing gain, operative time, graft uptake, presence of discharge or granulations, and postmastoidectomy quality of life will be compared for both the groups. Materials and Methods: This is a prospective analytical study of 40 patients with chronic otitis media, squamosal type, operated in the department of ENT over 10 months. All patients with cholesteatoma in any age group with intact stapes suprastructure encountered intraoperatively were included in this study; however, patients with intracranial or intratemporal complications and residual or recurrent disease requiring revision surgery were excluded. Patients were randomly allocated to two groups and were regularly followed to assess the condition of the postoperative cavity, to evaluate the efficacy in eradicating the disease and hearing gain, and to assess cavity problems. Results: The mean age of presentation was 32 years in our study. Ear discharge and hearing loss were the most common presenting symptoms. Thirty-eight patients had completely dry postoperative cavities and 1 patient in both the groups had discharge and granulations at 3-month follow-up period. The mean air–bone gap closure in the inside-out approach group was 16.25 dB, and for the conventional approach, it was 14.25 dB. The mean time of surgery showed a significant difference, with the mean being 100.25 min for inside-out approach group and 150 min for the conventional approach group. Conclusion: There is no significant difference in terms of hearing gain or postoperative dry cavities in both the groups, but the operative time is significantly reduced in the inside-out approach as the size of the cavity is significantly smaller.