Wall Of Auditory Canal Research Articles

Predictors of round window membrane visibility in pediatric cochlear implant surgery using temporal bone HRCT: A retrospective study

ObjectiveTo predict round window membrane (RWM) visibility and electrode insertion sites using high-resolution computed tomography (HRCT) in pediatric cochlear implant surgery. Materials and methodsSixty-two ears of 36 infants less than 1 year old were included in our study. Intraoperative RWM visibility was classified into three types corresponding to three different surgical approaches. Radiologic parameters were measured on preoperative axial temporal HRCT images and correlated with RWM visibility and surgical approaches. ResultsA significant correlation was found between the degree of RWM visibility and the following two parameters: 1) a line (lw) was drawn from the posterior margin of the RWM to the intersection point of the posterior wall of the external auditory canal (EAC) and mastoid cortex. Another line (lf) was drawn between the posterior margin of the RWM and the lateral margin of the FN. The angle between lw and lf was measured as angle A, P < 0.01, R2 = −0.809; 2) a line (lm) was drawn from the anterior to posterior margin of the RWM, and the angle between lm and lf was measured as angle B, P < 0.01, R2 = −0.850. A nonsignificant correlation was found between the degree of RWM visibility and the facial recess width, p > 0.05, R2 = −0.00015. ConclusionRWM visibility showed a high correlation with the two angular measurements (angle A and angle B) and was associated with electrode insertion sites. In children less than one year old, surgeons can depend on those two parameters in predicting the RWM visibility.

Prevalence and clinical features of diverticulum-like cavity on the anterior wall of the internal auditory canal in patients with otosclerosis

Prevalence and clinical features of diverticulum-like cavity on the anterior wall of the internal auditory canal in patients with otosclerosis

Retrosigmoid Approach for Vestibular Schwannoma

Vestibular schwannoma is a benign tumor that affects 3% of the population, but accounts for 85% of tumors occurring at the cerebellopontine angle (CPA). In this case, we present a 48-year-old female with history of cholesteatoma on the right and chronic suppurative otitis media on the left who presented with an 18 month history of bilateral hearing loss, worse on the right. Investigations revealed a right sided vestibular schwannoma measuring 1.6 cm in diameter. Audiogram revealed an AAO–HNS (American Academy of Otolaryngology–Head and Neck Surgery) class C hearing on the right and class B on the left. There are several management options for this size of vestibular schwannoma including observation and radiosurgery. However, preserving cochlear nerve function remains a challenging enterprise. Furthermore, the ideal management that confers the highest chance of hearing preservation remains heavily debated. Given the patient's young age, the goal of hearing preservation and the tumor size/extension into the CPA, surgery was decided through a right retrosigmoid transmeatal approach for tumor resection with intraoperative brain auditory evoked responses monitoring. For hearing preservation, we emphasize few important dissection techniques: tumor debulking from the top first to avoid early manipulation of the cochlear nerve at the bottom of the tumor, sharp dissection from medial to lateral off the vestibular nerve which is kept intact as a tension band to minimize cochlear nerve manipulations, and limit the drilling of the posterolateral wall of the internal auditory canal (IAC) medial to the labyrinth and endolymphatic apparatus. Postoperatively, the patient was discharged home within 2 days, with imaging showing a gross total resection. Follow-up audiogram shows unchanged pure tone thresholds. The link to the Video can be found at: https://youtu.be/Z5ftkpJN5k8 .

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears

IntroductionMicrosurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. ObjectiveThe aim of this study is to determine anatomic variations of the middle ear in an autopsy series. MethodsAll evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. ResultsOne hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. ConclusionThe pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Surgeon Oriented Preoperative Radiologic Evaluation in Cochlear Implantation - Our experience with a Proposed Checklist.

Introduction Preoperative temporal bone imaging studies have been routinely performed prior to cochlear implantation. Radiologists need to report these examinations with special focus on the surgeon's expectations. Objectives To provide a basic structured format, in the form of a checklist, for reporting preoperative computed tomography (CT) and to its clinical impact on operative findings. Methods The preoperative temporal bone CT scans of 47 patients were analyzed and reported according to the proposed checklist. Intraoperative assessment of mastoidectomy, posterior tympanotomy and round window access was done by the surgeon in a blinded fashion and were correlated with the radiological findings to assess its significance. Results The proposed radiological checklist was reliable in assessing operative difficulty during cochlear implantation. Contracted mastoid and lower tegmen position were associated with a greater difficulty of the cortical mastoidectomy. Presence of an air cell around the facial nerve (FN) was predictive of easier facial recess access exposure. Facial nerve location and posterior external auditory canal (EAC) wall inclination were predictive of difficult round window (RW) accessibility. Conclusion Certain parameters on the preoperative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.

3D fiber deposited polymeric scaffolds for external auditory canal wall.

The external auditory canal (EAC) is an osseocartilaginous structure extending from the auricle to the eardrum, which can be affected by congenital, inflammatory, and neoplastic diseases, thus reconstructive materials are needed. Current biomaterial-based approaches for the surgical reconstruction of EAC posterior wall still suffer from resorption (biological) and extrusion (synthetic). In this study, 3D fiber deposited scaffolds based on poly(ethylene oxide terephthalate)/poly(butylene terephthalate) were designed and fabricated to replace the EAC wall. Fiber diameter and scaffold porosity were optimized, leading to 200 ± 33 µm and 55% ± 5%, respectively. The mechanical properties were evaluated, resulting in a Young's modulus of 25.1 ± 7.0 MPa. Finally, the EAC scaffolds were tested in vitro with osteo-differentiated human mesenchymal stromal cells (hMSCs) with different seeding methods to produce homogeneously colonized replacements of interest for otologic surgery. This study demonstrated the fabrication feasibility of EAC wall scaffolds aimed to match several important requirements for biomaterial application to the ear under the Tissue Engineering paradigm, including shape, porosity, surface area, mechanical properties and favorable in vitro interaction with osteoinduced hMSCs. This study demonstrated the fabrication feasibility of outer ear canal wall scaffolds via additive manufacturing. Aimed to match several important requirements for biomaterial application to ear replacements under the Tissue Engineering paradigm, including shape, porosity and pore size, surface area, mechanical properties and favorable in vitro interaction with osteo-differentiated mesenchymal stromal cells.

Cavitary Plaques in Otospongiosis: CT Findings and Clinical Implications.

Cavitary plaques have been reported as a manifestation of otospongiosis. They have been related to third window manifestations, complications during cochlear implantation, and sensorineural hearing loss. However, their etiology and clinical implications are not entirely understood. Our purpose was to determine the prevalence, imaging findings, and clinical implications of cavitary plaques in otospongiosis. We identified patients with otospongiosis at a tertiary care academic medical center from January 2012 to April 2017. Cross-sectional CT images and clinical records of 47 patients (89 temporal bones) were evaluated for the presence, location, and imaging features of cavitary and noncavitary otospongiotic plaques, as well as clinical symptoms and complications in those who underwent cochlear implantation. Noncavitary otospongiotic plaques were present in 86 (97%) temporal bones and cavitary plaques in 30 (35%). Cavitary plaques predominated with increasing age (mean age, 59 years; P = .058), mostly involving the anteroinferior wall of the internal auditory canal (P = .003), and their presence was not associated with a higher grade of otospongiosis by imaging (P = .664) or with a specific type of hearing loss (P = .365). No patients with cavitary plaques had third window manifestations, and those with a history of cochlear implantation (n = 6) did not have complications during the procedure. Cavitary plaques occurred in one-third of patients with otospongiosis. Typically, they occurred in the anteroinferior wall of the internal auditory canal. There was no correlation with the degree of otospongiosis, type of hearing loss, or surgical complications. Cavitary plaques tended to present in older patients.

Preoperative evaluation of cochlear implantation through the round window membrane in the facial recess using high-resolution computed tomography.

We evaluated the risk of cochlear implantation through the round window membrane in the facial recess through a preoperative analysis of the angle between the facial nerve-round window and the cranial midline using high-resolution temporal bone CT. Temporal bone CT films of 176 patients with profound sensorineural hearing loss at our hospital from 2013 to 2015 were reviewed. The preoperative temporal bone CT scans of the patients were retrospectively analysed. The vertical distance (d value) from the leading edge of the facial nerve to the posterior wall of the external auditory canal and the angle (α value) between the line from the leading edge of the facial nerve to the midpoint of the round window membrane and the median sagittal line on the round window membrane plane were measured. Based on intraoperative observation, the round window membrane was divided into complete round window membrane exposure (group A), partial exposure (group B), and unexposed (group C) groups, and statistical analysis was performed. The α value could be effectively measured for all 176 patients (62.60 ± 7.12), and the d value could be effectively measured for 95 cases (5.53 ± 1.00). An analysis of the correlation between the α and d values of these 95 cases found a negative correlation. Of the 176 cases, one-way analysis of variance (ANOVA) showed that the differences among the groups were significant [P = 0.000 (< 0.05)]. The angle (α value) between the line connecting the leading edge of the facial nerve to the midpoint of the round window and the median sagittal line measured in preoperative CT scans was associated with the difficulty of intraoperatively exposing the round window membrane. When the α value was larger than a certain degree, the difficulty of exposing the round window membrane was increased. In such cases, the surgeon should fully expose the round window membrane during surgery, which could result decrease the likelihood of complications.

The method of cochlea-sparing surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone

Surgical treatment of patients with infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone involves the radical excision of the formation, often together with the cochlea, which results in the development of the degree 4 of chronic sensorineural hearing loss in the postoperative period. This article presents a method of cochlea-sparing surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone. This method is applicable to the patients with the preserved function of the auditory analyzer without the extension of cholesteatoma to the labyrinth and high position of the bulb of the jugular vein. The method includes skeletonization of the fallopian canal, expansion of the hypothympanum by removal the bone shelf of the lower wall of the external auditory canal together with the tympanic ring up to the jugular vein bulb, as well as by removal the bone shelf of the anterior wall of the external auditory canal up to temporo-mandibular joint, and thinning of the cochlear capsule up to its membranous region. After that, the sinuses of hypothympanum, infralabyrinthine cellular tract, pericarotid and precaratid cells are removed up to the internal carotid artery, going deeper to the top of the temporal bone pyramid. In this case, before the fallopian canal skeletonization, the access through retroaural approach with extended anthro-mastoidotomy, the excision of malleus, incus, all cells of the cellular tract of the temporal bone. Simultaneously with the phallopian canal skeletonization, intra-operative monitoring of the facial nerve is performed using needle electromyography by means of a drill until the occurrence of threshold events at the current of 0.8 to 0.5 mA; the formed trepanation cavity is sanitized, after that the external auditory canal is plastically expanded, and type 3 or 4 tympanoplasty with ossiculoplasty is performed, depending on the degree of damage of the sound-conducting system of the middle ear; in the post-surgical period the trepanation cavity is managed open. The method provides the reduction of cholesteatoma recurrence development risk and saves the hearing of the patients. The results of the treatment were evaluated using otomicroscopy, temporal bone MSCT, MRI of the middle ear in DWI-mode in the follow-up period of 6 months through 3 years.

The method of surgical treatment of acquired soft tissue atresia of the bone part of the external auditory canal

The main problem of acquired external auditory canal atresia is the low efficacy of surgical treatment due to high risk of restenosis. The authors have developed a method for elimination of atresia, aimed at the removal of causes of restenosis. It includes the expansion of the external auditory canal, the formation of a skin flap on the feeding base of the anterior wall of the external auditory canal, a prolonged tamponade and the use of a silicone protector. 20 patients have been operated using this method. Air conduction was improved by 23±5 dB and bone-air interval was decreased from 43±2 dB to 30±2 dB. Due to conservative treatment, the result was preserved in 80% of patients.

An abrupt bleeding of the anteriorly- displaced sigmoid sinus: a rare complication of myringoplasty

BackgroundThe location of the sigmoid sinus within the mastoid cavity is quite variable. An anteriorly- displaced vertical segment of the sigmoid sinus constitutes an uncommon but dangerous anatomical variation that surgeons rarely encounter during surgery. In this variation, the sigmoid sinus lays underneath a very thin bony flap, which makes it easily damaged. Thus, an abrupt fatal bleeding might occur. Despite the many hypotheses about its origin (Chronic otitis media, hypopneumatization, etc.), the pathogenesis of this variation is still not completely understood.Case presentationWe present a case where the vertical segment of the left sigmoid sinus was encountered just underneath a one- millimeter bony flap in the posterior wall of the external auditory canal during an attempted myringoplasty.ConclusionAnatomical variations of the sigmoid sinus are not uncommon, and the otolaryngologist should be aware of such variations to prevent unpleasant, intra- operative surprises.

Usefulness of High-Resolution 3D Multi-Sequences for Peripheral Facial Palsy: Differentiation Between Bell's Palsy and Ramsay Hunt Syndrome.

To investigate the usefulness of magnetic resonance imaging (MRI) including three-dimensional (3D) sequences in the differentiation between Bell's palsy (BP) and Ramsay Hunt syndrome (RHS). A prospective study. Tertiary care center. Twenty patients: 15 patients with BP and five patients with RHS. Diagnostic. Clinical diagnosis (BP or RHS). The presence of hyperintensity on 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) and enhancement on gadolinium-enhanced (CE)-3D-FLAIR and CE-3D-T1-weighted image (3D-T1WI) along the internal auditory canal (IAC) wall were significantly associated with RHS (p < 0.05). Hyperintensity in the inner ear was observed on pre- and postcontrast 3D-FLAIR, and enhancement of the cranial nerve (CN)-VIII was observed only on CE-3D-FLAIR. The presence of these findings also showed significant relationships with RHS (p < 0.05). Moreover, thickening of the CN-VII in the fundus of the IAC in 3D-constructive interference on steady state sequence (3D-CISS) also showed a significant association with RHS (p < 0.05). In contrast, the presence of hyperintensity of the CN-VII in the fundus of the IAC on 3D-FLAIR did not demonstrate a significant relationship (p = 0.95), and enhancement in this region was observed in all cases on CE-3D-FLAIR and gadolinium-enhanced-three-dimensional-T1-weighted gradient echo sequence (CE-3D-T1WI). 3D MRI sequences are useful for differentiating RHS from BP. In particular, the enhancement in the CN-VIII and/or along the IAC wall are valuable findings, and CE-3D-FLAIR is the most useful sequence to evaluate these findings. Thickening of the CN-VII on 3D-CISS is also an important finding.

The Prevention of Recurrent Cholesteatoma in CWU Surgery: The Use of Titanium Sheeting.

Assessment of the outcomes of a technique of prevention of recurrent cholesteatoma in canal wall up (CWU) mastoidectomy, using titanium sheeting to repair the external auditory canal wall. Sixty four cholesteatoma cases were managed during a period from 2007 to 2015. The cases were unselected; the surgery was performed by the senior author. Cholesteatoma Patterns Were: Forty two attic, nine pars tensa, seven combined attic-pars tensa, three congenital, and three other. Primary surgery was undertaken in 33 cases. All cases underwent CWU surgery that employed canal wall repair using fine titanium sheeting combined with overlying organic material to repair canal wall defects. Drum repairs employed cymba conchae cartilage-perichondrium composite grafts. Chain reconstruction used Spanner struts or Grace Alto PORPs or TORPS. Two cases suffered mesotympanic residual disease, and three, mesotympanic recurrence one of which extended into the attic. Two other cases incurred atticomastoid residues. Transient myringitis occurred in three cases. The surgery was judged on its ability to avoid atticomastoid recurrence, and was regarded as highly successful. The titanium sheeting offers a relatively simple but effective technique. The mesotympanic complications are those also commonly found in both CWD and other CWU methods. As in other CWU procedures, the problems of the open cavity were avoided.

Clinical observation on the treatment of intractable otomastoiditis with reconstruction of external auditory canal wall

Objective:To observe the clinical effect on the treatment of intractable tympanitis with reconstruction of external auditory canal wall.Method:Five cases underwent radical removel of residual lesion and reconsruction of external auditory posterior canal wall using hydroxyapatite ceramic wall with transferred pedicle temporalis fascia covering on it were analyzed. The implement of ossicular chain reconstruction depends on the probing for tympanic cavity intraoperatively. Periodic review were conducted in the 1st, 3rd, 6th, 12th month after surgery.Result:All 5 cases gained dryears within 3 months after surgery, in which hearing of 3 cases improved and ABG were within 20 dB. 1 cases showed no improvement compared to preoperation, and 1 case gained a worse audiology result. Central part of the transplant of 1 case was naked, while peripheral part had been epithelization and external auditory canal gained no accessible to mastoid cavity, the patient were also found recurrence of cholesteatom inside the mastoid cavity when received CT examination during outpatient follow-up one year postoperatively, and underwent correction surgery. 1 case underwent revision operation for a fistula between the reconstructed wall and the skin of the outer auditory canal. No surgical complications like infection or facial paralysis occurred, all patients were satisfied with surgery effect.Conclusion:HA with transferred vascularized temporalis fascia pedicle for the reconstructon of the external auditory canal wall is an effective method for the treatment of intractable tympanitis, and worth promoting.

Significance of intraoperative findings in revision tympanomastoidectomy

PurposeThe study was designed to assess correlations between intraoperative findings in revision tympanomastoidectomy as predictors of cholesteatoma recurrence. Materials and methodsA retrospective single-institution cohort of 101 patients who underwent surgical treatment for recurrent chronic otitis media in a tertiary referral otology centre. ResultsOut of 101 patients, 65 had canal wall up and 36 canal wall down revision surgery. There were 35 cholesteatoma recurrences. Sites most commonly associated with recurrent disease were residual facial ridge cells in 46 (45.5%), ossicular chain sites in 46 (45.5%) patients, posterior external auditory canal wall erosions in 38 (37.6%) patients and mastoid apex recurrence in 35 (34.7%) patients. Ossicular and posterior external auditory canal wall erosion and incomplete removal of mastoid apex cells correlate well with cholesteatoma recurrence accompanied by canal wall up surgery (p=0.009). Residual mastoid apex cells, posterior external auditory canal wall erosion and presence of residual facial ridge cells were identified as the strongest positive predictors of cholesteatoma recurrence, identifying high risk patients associated with canal wall down procedures (p=0.0036). ConclusionsCorrelations between intraoperative findings and cholesteatoma recurrence could improve preoperative and intraoperative planning and reduce the rates of postoperative failures1 due to mismanagement of high risk areas.

Facial Nerve Function and Quality of Resection in Large and Giant Vestibular Schwannomas Surgery Operated By Retrosigmoid Transmeatal Approach in Semi-sitting Position with Intraoperative Facial Nerve Monitoring.

Large and giant vestibular schwannomas pose a real problem in their management. The preservation of facial nerve function may limit tumor resection despite the use of intraoperative monitoring of the facial nerve. In Algeria, vestibular schwannomas represent 5% of all intracranial tumors operated on, 80.5% of which are large or giant. From January 2010 to December 2015, 151 large and giant vestibular schwannomas were operated in our department. Tumor diameter was between 30 and 60mm. The most common presenting symptom was hearing loss, which was observed in 41.66% of all our patients. All patients were operated in the semi-sitting position with opening of the posterior wall of the internal auditory canal and under continuous intraoperative facial nerve function monitoring. Tumor resection was total in 126 patients. Anatomic preservation of the facial nerve was the reason for nontotal resection in 25 patients. The facial nerve was anatomically preserved in 149 patients. Two years after surgery, the facial nerve function was grade I-II House-Brackmann (H-B) score in 124 cases (82%),grade III-IV H-B score in 21 cases (14%), and grade V-VI H-B score in 06 cases (04%). The status and the improvement of postoperative facial nerve function depend on 4 factors: anatomic preservation of nerve,stimulation threshold, cystic form, and the presence of train activity. The development of anesthesia techniques and microsurgery and the systematic use of intraoperative monitoring of the facial nerve have allowed us to move from a life preservation era to another era of preservation of function.

Endoscopic management of congenital cholesteatoma

Congenital cholesteatomas are epithelial cell rests found within the middle ear or mastoid that are present behind an intact tympanic membrane. Typically found early in life, these expansile skin cysts can result in conductive hearing loss by impeding or eroding the ossicular chain. If left unaddressed, congenital cholesteatoma can result in erosion of the bony labyrinth, tegmen, or facial nerve resulting in significant patient morbidity. Surgical removal of congenital cholesteatoma is recommended, preferably when the lesions are small. When considering a surgical approach for the removal of congenital cholesteatoma, surgeons should consider the size and location of the lesion as well as the extent of expected reconstruction. Transcanal endoscopic ear surgery can successfully be used to manage congenital cholesteatoma limited to the tympanic cavity. Patient features that favor an endoscopic approach include a circumscribed, unruptured congenital cholesteatoma, intact external auditory canal wall, and absence of secondary complications such as labyrinthine fistula, middle fossa extension, or facial nerve paresis. We describe our endoscopic operative approach to remove congenital cholesteatoma and also highlight effective methods of tympanic reconstruction.

真珠腫性中耳炎に対する経外耳道内視鏡下耳科手術における外耳道後壁削開面積の検討

真珠腫性中耳炎に対する経外耳道内視鏡下耳科手術における外耳道後壁削開面積の検討

Application of a computer-assisted surgical navigation system in temporomandibular joint ankylosis surgery: a retrospective study

This retrospective study evaluated the effect of surgical computer-assisted navigation in temporomandibular joint (TMJ) ankylosis gap arthroplasty. Eighteen patients (25 sides) with bony ankylosis who underwent surgical treatment under computer-assisted navigation (navigation group) from May 2011 to April 2013 were assessed, along with 19 such patients (25 sides) treated without computer-assisted navigation (non-navigation group) from March 2009 to April 2011. The navigation group patients underwent surgery with the preservation of ≥3mm bone thickness in the skull base and anterior wall of the external auditory canal. Postoperatively, computed tomography (CT) was used to measure the residual bone thickness in the skull base and anterior wall of the external auditory canal. Maximum mouth opening (MMO) changes were evaluated at >1 year of follow-up. Postoperative CT measurements showed that the lowest skull base thickness in the navigation group was significantly lower than that in the non-navigation group (3.86±1.95mm vs. 6.01±3.07mm, P=0.009). The lowest thicknesses of the anterior wall of the external auditory canal were similar in the two groups. Postoperative follow-up showed similar average MMO in the two groups. Therefore, with the navigation system, TMJ ankylosis gap arthroplasty can achieve more extensive removal of the ankylosed bone, at least towards the skull base, under the premise of ensuring a safety distance of 3mm.

The resected area of the posterior wall of the external auditory canal during transcanal endoscopic ear surgery for cholesteatoma.

The aim of this study was to evaluate part of the area of the posterior wall of the external auditory canal (EAC) that is resected during transcanal endoscopic ear surgery (TEES) for cholesteatomas that extend to the mastoid cavity, and to determine whether TEES is a minimally invasive surgical procedure for cholesteatoma. This was a retrospective study involving 25 patients with cholesteatoma that extended to the mastoid cavity, and who underwent surgery between October 2014 and October 2015. The patients' cholesteatomas were removed using TEES. In this procedure, the superoposterior wall of the EAC was resected in order to access the deepest part of the cholesteatoma. We made a paper template by tracing the shape of the resected EAC and then reconstructed the resultant defect with a piece of cartilage, the size of which was based on the size of the template. We evaluated the size and greatest dimension of the resected part of the EAC by measuring the template. Preoperatively, we also evaluated the volume of each cholesteatoma on computed tomography (CT) images. The median size of the resected region was 37.3 (14.7-68.4)mm2. The median length of the greatest dimension of the resected area was 8.7 (5.1-15.9)mm. The median cholesteatoma volume was 417 (43-1399)mm3. The correlation coefficient (R2) obtained using a two-thirds order approximation curve for the relationship between the resected tissue area and the cholesteatoma volume (0.617) was higher than that obtained by linear approximation (0.387). These results suggest that the resected area was minimal and of an appropriate size relative to the volume of the cholesteatoma.