Poorly performed modified radical mastoidectomy.

The otoscopic view is that of a right ear that had undergone a modified radical mastoidectomy. The anterior external auditory canal and the inferior external auditory canal can be seen. The pars tensa, malleus, and incus are visible; they were left untouched. The pars tensa is thickened with tympanosclerosis, and there is a suggestion of serous fluid within the tympanum. The chorda tympani crosses from the posterior canaliculus anteriorly, lateral to the incus and medial to the malleus. The superior external auditory canal and the posterior external auditory canal were previously removed, and the cavity is lined with a very thin layer of squamous epithelium. The cavity contains many partially uncovered mastoid air cells, which are the source of a recurring accumulation of epithelial debris that is causing a foul-smelling discharge. At the anterosuperior edge of the epitympanum, the membrane is thin and appears to seal the middle ear from the cavity.

The Bondi modified radical mastoidectomy was developed during the 19th century to treat attic cholesteatoma by exteriorization to make the ear "safe" while preserving middle ear structures and hearing. Modern tympanoplasty techniques have made this operation obsolete.

From the Pulec Ear Clinic, Los Angeles (Dr. Pulec), and Gap, France (Dr. Deguine).