Functional and Anatomical Outcomes of Modified Radical Mastoidectomy (Bondy Technique) as Surgical Treatment for Cholesteatoma

Abstract

Abstract:  The Bondy technique is a surgical procedure designed specifically to treat cholesteatoma confined to the attic and lateral to the ossicular chain. It is classically indicated in patients with an intact ossicular chain and an undamaged tympanic membrane. This technique may also be employed in cases of extensive external auditory canal (EAC) cholesteatomas distant from the tympanic cavity that nonetheless cause significant erosion of the EAC and mastoid.

Objective: To demonstrate that preserving the ossicular chain through the modified Bondy technique enables complete disease eradication, hearing preservation, and postoperative quality of life.

Materials and methods: We report five cases of patients treated with the modified Bondy technique at a tertiary care center between 2023 and 2024, all diagnosed with cholesteatoma localized to the epitympanum. Pre- and postoperative pure-tone audiometry and the COMQ-12 quality-of-life questionnaire were applied by the institute’s audiology department.

Results: Three patients demonstrated objective postoperative audiometric improvement, with a reduction in the air-bone gap and auditory reserve, suggesting enhanced sound transmission. One of these patients achieved values consistent with normal hearing. Two patients did not show significant audiometric improvement; in one case, the presence of anatomical abnormalities (grade II microtia) likely influenced the outcome. Postoperative COMQ-12 scores indicated favorable results, except for one patient who reported persistent symptoms (tinnitus and dizziness). These findings suggest that the Bondy-type mastoidectomy may improve hearing and quality of life in selected patients with external auditory canal cholesteatoma.

Conclusion: This surgical technique is a viable and effective approach for the management of extensive EAC cholesteatomas. Based on our findings, we advocate its use as a therapeutic alternative to conservative management or canaloplasty to achieve disease control, preserve hearing, and improve quality of life.

Keywords: Mastoidectomy, modified radical mastoidectomy (Bondy type), middle ear, cholesteatoma, ossicular chain.