Question:
The treatment of choice for atticoantral variety of CSOM is
The treatment of choice for atticoantral variety of CSOM is
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Atticoantral CSOM usually means cholesteatoma, and only surgery (mastoidectomy) can clear it.
Updated On: Jul 8, 2026
- Mastoidectomy
- Medical management
- Underlay myringoplasty
- Insertion of ventilation tube
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The Correct Option is A
Solution and Explanation
Step 1: Classify chronic suppurative otitis media (CSOM).
CSOM is divided into two types. The tubotympanic (safe) type has a central perforation and mainly mucosal disease. The atticoantral (unsafe) type has a marginal or attic perforation and is usually associated with cholesteatoma, skin trapped inside the middle ear and mastoid that slowly destroys bone.
Step 2: Understand why the atticoantral type is called unsafe.
Cholesteatoma can erode the ossicles, the bony wall of the facial nerve canal, the labyrinth, and even the roof of the middle ear or mastoid, leading to complications such as facial palsy, a labyrinthine fistula, meningitis, or a brain abscess. Medicines cannot remove this skin debris or stop the bone erosion.
Step 3: Identify the correct treatment.
Because the disease is a destructive, expanding mass rather than a simple infection, the only way to clear it and prevent complications is surgical removal of the diseased mastoid air cells and cholesteatoma matrix, done through a mastoidectomy.
Step 4: Rule out the other options.
(B) Medical management: Antibiotic ear drops or systemic antibiotics can control secondary infection for a while but cannot clear cholesteatoma or stop bone destruction, so this is not curative.
(C) Underlay myringoplasty: This repairs a simple central perforation in tubotympanic disease. It does not address mastoid cholesteatoma, so it is wrong here.
(D) Insertion of a ventilation tube: This is used for otitis media with effusion (glue ear), not for cholesteatoma disease of the attic and antrum.
Step 5: Final Answer.
The treatment of choice for atticoantral CSOM is mastoidectomy.
\[ \boxed{\text{Mastoidectomy}} \]
CSOM is divided into two types. The tubotympanic (safe) type has a central perforation and mainly mucosal disease. The atticoantral (unsafe) type has a marginal or attic perforation and is usually associated with cholesteatoma, skin trapped inside the middle ear and mastoid that slowly destroys bone.
Step 2: Understand why the atticoantral type is called unsafe.
Cholesteatoma can erode the ossicles, the bony wall of the facial nerve canal, the labyrinth, and even the roof of the middle ear or mastoid, leading to complications such as facial palsy, a labyrinthine fistula, meningitis, or a brain abscess. Medicines cannot remove this skin debris or stop the bone erosion.
Step 3: Identify the correct treatment.
Because the disease is a destructive, expanding mass rather than a simple infection, the only way to clear it and prevent complications is surgical removal of the diseased mastoid air cells and cholesteatoma matrix, done through a mastoidectomy.
Step 4: Rule out the other options.
(B) Medical management: Antibiotic ear drops or systemic antibiotics can control secondary infection for a while but cannot clear cholesteatoma or stop bone destruction, so this is not curative.
(C) Underlay myringoplasty: This repairs a simple central perforation in tubotympanic disease. It does not address mastoid cholesteatoma, so it is wrong here.
(D) Insertion of a ventilation tube: This is used for otitis media with effusion (glue ear), not for cholesteatoma disease of the attic and antrum.
Step 5: Final Answer.
The treatment of choice for atticoantral CSOM is mastoidectomy.
\[ \boxed{\text{Mastoidectomy}} \]
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