Abstract
Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft, characterized by discharging ear and permanent perforation. CSOM is one of the most common disease in our country, it affects both sexes and all ages. It is also the single most important cause of hearing impairment in rural population. CSOM clinically is of two types, 1 Tubotympanic (safe type), 2 Atticoantral (unsafe type). Atticoantral involves posteriosuperior part of ear cleft ( attic, antrum and mastoid) and associated with a bone eroding process such as cholesteatoma, granulation, osteitis and the risk of complication is very high in this type.
This was a prospective interventional study, conducted to assess the intra-operative findings during Canal Wall down mastoidectomy in patients for unsafe type of CSOM in department of ENT and Paediatrics at Ghulam Muhammad Mahar Medical College Hospital Sukkur, from June 2009 to June 2011. Eighty patients, of age ranged from 5-55 years of both sexes were included in this study. Majority were females 48 (60%). Granulation tissue was found in 50 (62.5%) of cases, while cholesteatoma in 30 (37.5%) of cases. The extent of primary disease involvement, in attic 4 (5%), attic and middle ear 30 (37.5%), attic and antrum 16 (20%), and attic, antrum and middle ear 30 (37.5) were found. In majority of the cases, there were involvement of more than one ossicle, among the most affected single ossicle malleus was found necrosed in 50 (62.5%), incus was found necrosed in 42 (52.5%), and stapes was found necrosed in 20 (25%) of cases. The primary disease found in our patients, undergone canal wall down mastoidectomy were most common granulation tissue and less cholesteatoma and multiossicular damage was commonly noted.

Key words: Canal wall down mastoidectomy, granulation tissue, ossicular damage, CSOM.