Abstract
Cholesteatoma is life-threatening disease due to its intracranial complications. Some of cholesteatoma cases we define as aggressive cholesteatoma. In this category we include children cholesteatoma, medially-invasive cholesteatoma and petrous apex cholesteatoma which does not originate in the petrous apex. Another special form of cholesteatoma is petrous bone cholesteatoma. Retrospective study of 176 cholesteatoma operations (38.85%) from 453 consecutive middle ear surgeries for 4 years and 4 months in Trakia Park Hospital Stara Zagora, Bulgaria were rewieved. The same surgeon performs 106 Primary Cholesteatoma Surgery, 49 Revision Surgery and 21 Second-Look Surgery. In this 176 cholesteatoma cases the cholesteatoma matrix involve the otic capsule, petrous apex or skull base in 5 patients, who are defined as medially-invasive cholesteatoma (2.84%). In this medially-invasive cholesteatoma patients surgical resection with canal wall down operation remains the best treatment option.
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