Modern otological care and antibiotics seem to have changed the occurrence of cholesteatomas. Secondary Cholesteatomas, accompanying severe infection, and resulting destruction by osteitis seem to have decreased in number of occurrences, but primary and rather rare genuine cholesteatomas are as frequent as before. Because of so few instances of destruction by inflammation, they tend to grow into depths of petrous pyramid.
The best method of early direct exposure, enucleation of cholesteatoma sac, individual conservative adaptation of surgery, and complete reconstruction of middle ear as well as external meatus is the so-called osteoplastic epitympanotomy.
Wullstein HL, Wullstein SR. The Problem of the Hidden Primary Cholesteatoma in Tympanoplasty. Arch Otolaryngol. 1973;97(2):194–197. doi:10.1001/archotol.1973.00780010200024
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