Management of Cholesteatoma

"Most otologic surgeons prefer to avoid operating on an only hearing ear. Preoperative scanning can not only help determine the risk of observation, but if no evidence of disease is seen in the middle ear space, a modified radical mastoidectomy (without tympanoplasty) can be justified. Some surgeons believe that avoiding surgery in the middle ear space reduces the risk of postoperative hearing loss."

Peter S. Roland

"The added safety of a second look procedure, however, does not preclude primary reconstruction of the ossicular chain in most cases. Thus it is not necessary to commit the patient to months of a large or maximal conductive loss just because a second look procedure may be indicated at a later time. It is the author's practice to delay ossicular reconstruction in only certain circumstances such as cases in which the middle ear mucosa has been replaced by granulomatous disease in which time is necessary to achieve a mucosalized and aerated middle ear compartment, or in such cases in which the footplate is fixed and stapedectomy will be necessary for hearing reconstruction."

Joseph B. Nadol, Jr.

"Residual cholesteatoma is not related to recurrent cholesteatoma. Recurrent cholesteatoma rarely develops in canal wall down procedures. Recurrent cholesteatoma is preventable: residual cholesteatoma is not. The incidence of residual cholesteatoma in the middle ear is the same (in our hands), CWU or CWD."

James L. Sheehy

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