Making Decisions


If surgery is necessary, how soon should it be performed? Unless there is some clear-cut indication of an impending complication there is usually no reason to treat the active cholesteatoma as urgent. The exception is when the discharge is through a small attic perforation, and/or there is night pain, or a positive fistula test or facial weakness.

When the cholesteatoma has developed from a posterior superior retraction pocket (has a "large" opening) and there are


What tests one does preoperatively is an individual matter. At House Ear Clinic, we do not routinely take radiographs (CT scans) nor do we test eustachian tube function or culture the draining ear. Hearing tests (air, bone, and speech), are done immediately before surgery.


We are more likely to encourage early surgery in children with active cholesteatoma. Often their mastoids are well developed, and they have extensive cholesteatosis; in these cases, we are more likely to use the CWU. We are more likely to use a CWU in children because this avoids the problem that could come about with getting water in the ear.

In elderly patients, particularly if there is a major health problem, a CWD procedure, usually a modified radical mastoidectomy, is the best choice. "Simple and safe," and no need for staging.


In most cases, we do not monitor the facial nerve unless there is an impending complication or this is revision of an operation performed elsewhere.

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