Modified Radical Mastoidectomy: Definition
Modified radical mastoidectomy is a canal wall down surgical procedure for chronic ear disease that removes all mastoid air cells and creates an open cavity while preserving the tympanic membrane (or reconstructing it) and maintaining ossicular chain function when possible. 1, 2
Surgical Anatomy and Technique
The procedure differs from radical mastoidectomy by its preservation of key middle ear structures:
- The tympanic membrane and middle ear space are preserved or reconstructed, distinguishing it from radical mastoidectomy where these are removed 1, 2
- The ossicular chain remains intact when functional, allowing for potential hearing preservation 1, 3
- All mastoid air cells are removed with creation of an exteriorized cavity 2, 4
- The posterior canal wall is taken down to provide complete disease access 4, 5
Original Bondy Criteria for Modified Radical Mastoidectomy
The classic indications require all of the following 1:
- Intact pars tensa with defective pars flaccida containing cholesteatoma 1
- Normal or near-normal hearing preoperatively 1
- Intact, functional ossicular chain 1
- Cholesteatoma delineated lateral to the body of the incus (proposed fourth criterion based on disease control outcomes) 1
Clinical Context and Outcomes
Modified radical mastoidectomy addresses chronic suppurative otitis media with cholesteatoma:
- The procedure achieves disease eradication while maintaining hearing potential, with studies showing mean air conduction gain of 21.24 dB and air-bone gap closure of 15.62 dB 4
- Open cavity techniques carry 20-60% risk of persistent intermittent drainage, though cavity reconstruction with Palva flap reduces this to approximately 7% 2
- Hearing results are comparable to intact canal wall procedures when appropriate reconstruction is performed, with no significant bone conduction changes despite extensive drilling 3
- Better outcomes occur with primary surgery versus revision and when the stapes remains intact 3
Important Surgical Considerations
This is fundamentally different from modified radical mastectomy in breast surgery—the terminology overlap creates potential confusion, but these are completely distinct procedures in different anatomic regions 6, 1, 2.
For cholesteatoma in an only hearing ear, contemporary practice increasingly favors intact canal wall approaches over modified radical mastoidectomy when no labyrinthine fistula exists, as open cavity procedures carry higher risk of delayed sensorineural hearing loss 5.