Treatment of choice for atticoantral type of CSOM-

Ans. is 4c' i.e., Modified radical mastoidectomy Treatment of atticoantral diseaseo Since cholesteatoma is going to expand and destroy bone and mucous membrane, it has to be removed.o Therefore, surgery is the mainstay of treatment.o Primary aim is removal of disease by mastoidectomy to make ear safe followed by reconstruction of hearing at a later stage.o Modified radical mastoidectomy is the surgery of choice.o Two types of surgical procedures (mastoidectomy) are done to deal with cholesteatoma:-Canal wall down proceduresThese leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized.The commonly used procedures for atticoantral disease are atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy.Modified radical mastoidectomy is the procedure of choice.Canal wall up procedures (cortical mastoidectomy)Here disease is removed by combined approach through the meatus and mastoid but retaining the posterior bony meatus wall, thereby avoiding an open mastoid cavity.o For reconstruction of hearing mechanism myringoplasty or tympanoplasty can be done at the time of primary surgery or as a second stage procedure.