Introduction: In cases of chronic suppurative otitis media with attico–antral /postero superior marginal pathology, treatment modality is only surgery. Surgical options available are the canal wall down mastoidectomy and intact canal wall mastoidectomy.

Aim: To compare the post–operative results like recurrence of ear discharge, improvement in hearing and requirement of postoperative follow up in CSOM patients undergoing canal wall down mastoidectomy and canal wall upmastoidectomy.

Materials and Methods: 32 patients who attended ENT Department, GovtRajaji Hospital, Madurai from June 2007 to September 2009 were included in this study. The diagnosis of CSOM – atticoantral pathology with or without cholesteatoma or granulations was made on clinical grounds. Informed written consent was obtained before the initiation of the study. Mastoid cortex exposed and drilled. Cholesteatoma removed and disease clearance given with canal wall up mastoidectomy in 13 cases and with canal wall down mastoidectomy in the rest 19 cases.  Post–operative results like recurrence of ear discharge, improvement in hearing and requirement of postoperative follow up were studied and statistically analysed.

Results: In canal wall up mastoidectomy, only about 15% of cases had postoperative ear discharge⁷. About 69% of cases had improvement in hearing post operatively and 31% had no significant improvement and none had deterioration of hearing.  15% only required regular follow up post operatively. In canal wall down mastoidectomy, 26% had recurrence of ear discharge. About 37% of cases had improvement in hearing post operatively, 58% had no significant improvement in hearing and 5% had deterioration of hearing. 32% required regular follow up post operatively. Statistically significant postoperative improvement of hearing and less need for frequent follow up was noted in canal wall up mastoidectomy.

Conclusion: Canal wall up mastoidectomy is a better optionthan canal wall down mastoidectomysince the posterior canal wall is maintained with significant improvement in hearing post operatively.In addition there are nil cavity problems. Regular follow up for cavity cleaning is not required.