Future Research

The entire landscape of surgery for chronic otitis media will change significantly with new insights in restoration of normal eustachian tube function. In addition, most reconstructive procedures that are done in the middle ear are based more on intuition than scientific proof. Research in the area of middle ear mechanics and reconstruction34,35 is most welcome and will undoubtedly provide better methods of reconstruction in the future.



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2. Sheehy JL, Brackmann DE, Graham MD. Cholesteatoma surgery: residual and recurrent disease: a review of 1,024 cases. Ann Ctol 1977;86:451-462

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21. Erkan M, Aslan T, Sevuk E, et al. Bacteriology of chronic suppurative otitis media. Ann Otol Rhinol Laryngol 1994;103: 771-774

22. Merchant SN, Wang P, Jang CH, et al. Efficacy of tympa-nomastoid surgery for control of infection in active chronic otitis media. Laryngoscope 1997;107:872-877

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Revision Tympanomastoidectomy

There have been very few changes in the techniques of management of cholesteatoma since the mid-1970s, but controversies remain. It is not uncommon to attend a scientific meeting, listen to three presentations on a subject, and hear that each (different) technique or prosthesis is "the only way to do it." "It gives perfect results." "If you do it my way you will get results just like mine."

Of course, none of these statements is true. There are many ways to accomplish a desired result, but nothing works perfectly. The results you obtain will depend on your personal ability to use your hands and instruments and on your judgment. There's an old saying that judgment comes from experience, and experience comes from bad judgment! So what any of us do, or teach, is based on having had problems and learning how to avoid them: what to do, how to do it, and what not to do: judgment!

This chapter summarizes the many factors involved in making a decision on management of cholesteatoma, particularly the management of the mastoid. I leave it up to the reader to review articles mentioned in the Suggested Readings for in-depth discussion on various aspects of management.

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