Surgery for removal of cholesteatomas must satisfy two principles which appear contradictory: (1) A large opening must be made. This implies sacrifice of structures to permit eradication of the cholesteatoma. (2) One must conserve, to a maximum, elements which permit practice of good tympano-ossicular reconstruction.
Four methods are described: (1) The "closed" technique is method of choice in cases where maintenance or improvement of hearing is wished. (2) The "open" technique (radical mastoidectomy) with functional improvement is preferred each time there is an extensive process or where infection is involved. (3) When cholesteatoma exists in the attic, transmeatal atticotomy with repair of the external attic wall with cartilage is preferred. (4) In certain cases of large uninfected cavities, one uses obliteration.
Portmann M. Selection of Techniques for Cholesteatomas. Arch Otolaryngol. 1973;97(2):191–193. doi:10.1001/archotol.1973.00780010197023
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