Abstract
The surgical approach for removal of cholesteatoma is dictated by location, type, and extension of the cholesteatoma. In combined mastoidectomy and tympanoplasty, three approaches are advocated: (1) anterior atticotympanotomy with anterior thinning of the canal wall, (2) posterior transmastoid atticotympanotomy or facial recess approach with posterior thinning of the canal wall, or (3) modified radical mastoidectomy. The stapes and round window form the dividing line as indications for anterior or posterior thinning of the canal wall. This article is motivated by the high incidence of failures resulting from inaccurate and incomplete surgery of the past decade. It is dedicated to the complete removal of all the cholesteatoma so that a lasting result may be obtained with a one-stage tympanoplasty and mastoidectomy.
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