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.

REFERENCES

NadoI—CHAPTER SB

1. Smyth GDL. Postoperative cholesteatoma in combined approach tympanoplasty. JLaryngol Ctol 1976;90:591-621

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

3. Edelstein DR, Parisier SC. Surgical techniques and recidivism in cholesteatoma. CtolaryngolClin North Am 1989;22:1029-1039

4. Abramson M, Lachenbruch PA, Press BH, McCabe BF. Results of conservative surgery for middle ear cholesteatoma. Laryngoscope 1977;87:1281-1287

5. Schmid H, Dort JC, Fisch U. Long-term results of treatment for children's cholesteatoma. Am J Ctol 1991;12:83-92

6. Hirsch BE, Kamerer DB, Doshi S. Single-stage management of colesteatoma. Otolaryngol Head Neck Surg 1992;106: 351-354

7. Beales PH. The problem of the mastoid segment after tympanoplasty. J Laryngol Otol 1959;73:527-531

8. Palva T. Operative technique in mastoid obliteration. Acta Otolaryngol (Stockh) 1973;75:289-290

9. Saunders JE, Shoemaker DL, McElveen JT Jr. Reconstruction of the radial mastoid. Am J Otol 1992;13:465-469

10. Vartiainen E, Kansanen M. Tympanomastoidectomy for chronic otitis media without cholesteatoma. Otolaryngol Head Neck Surg 1992;106:230-234

11. Veldman JE, Braunius WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with long-term follow-up. Ann OtolRhinol Laryngol 1998;107:486-491

12. Shelton C, Sheehy JL. Tympanoplasty: review of 400 staged cases. Laryngoscope 1990;100:679-681

13. Brackmann DE. Tympanoplasty with mastoidectomy: canal wall up procedures. Am J Otol 1993;14:380-382

14. Vartiainen E, Vartiainen J. Hearing results of surgery for chronic otitis media without cholesteatoma. Ear Nose Throat J 1995;74:165-166, 169

15. Glassock ME III, Miller GW. Intact canal wall tympanoplasty in the management of cholesteatoma. Laryngoscope 1976;86: 1639-1657

16. Smyth GDL. Cholesteatoma surgery: the influence of the canal wall. Laryngoscope 1985;95:92-96

17. Proctor B. Attic-aditus block and the tympanic diaphragm. Ann OtolRhinolLaryngol 1971;80:371-375

18. Jokipii AMM, Karma P, Ojala, K, et al. Anaerobic bacteria in chronic otitis media. Arch Otolaryngol 1977;103: 278-280

19. Harker LA, Koontz FP. Bacteriology of cholesteatoma: clinical significance. Trans Am Acad Ophthalmol Otolaryngol 1977;84:683-686

20. Brook I. Aerobic and anaerobic bacteriology of cholesteatoma. Laryngoscope 1981;91:250-253

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

23. Nadol JB Jr. Causes of failure of mastoidectomy for chronic otitis media. Laryngoscope 1985;95:410-413

24. Nadol JB Jr, Krouse JH. The hypotympanum and infra-labyrinthine cells in chronic otitis media. Laryngoscope 1991; 101:137-141

25. Vartiainen E, Virtaniemi J. Findings in revision operations for failures after cholesteatoma surgery. Am J Otol 1994;15:229-232

26. Proctor B. Chronic middle ear disease. Arch Otolaryngol 1963; 78:276-283

27. Savic D, Djeric D. Surgical anatomy of the hypotympanum. J Laryngol Otol 1987;101:419-425

28. Sade J, Weinberg E, Berco M, et al. The marsupialized (radical) mastoid. J Laryngol Otol 1982;96:869-875

29. Nadol JB Jr. Chronic otitis media. In: Nadol JB Jr, Schuknecht HF, eds. Surgery of the Ear and Temporal Bone. New York: Raven Press; 1993:155-170

30. Sheehy JL, Crabtree JA. Tympanoplasty: staging the operation. Laryngoscope 1973;83:1594-1621

31. Smyth GDL. Surgical treatment of cholesteatoma: the role of staging in closed operations. Ann Otol Rhinol Laryngol 1988; 97:667-669

32 Tos M, Lau T. Attic cholesteatoma: recurrence rate related to observation time. Am J Otol 1988;9:456-464

33. Austin DF. Single-stage surgery for cholesteatoma: an actuarial analysis. Am J Otol 1989;10:419-425

34. Rosowski JJ, Davis PJ, Merchant SN, et al. Cadaver middle ears as models for living ears: comparisons of middle ear input immittance. Ann Otol Rhinol Laryngol 1990;99:403-412

35. Merchant NS, Rosowski JJ, Ravicz ME. Middle ear mechanics of type IV and type V tympanoplasty II. Clinical analysis and surgical implications. Am J Otol 1995;16:565-575

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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