How to Operate Middle Ear Cholesteatoma

Abstract

Takahashi reported that in surgical treatment of cholesteatoma by the canal up method, postoperative aeration of the mastoid cavity depends only on preservation of the mastoid mucosa and not on the ventilation routes made by anterior and/or posterior tympanotomy. Takahashi suggested that aeration of the mastoid is maintained by the gas exchange function of the preserved mucosa. In this paper, my refutation of Takahashi's theory will be described as follows:
1. His citation of the literature is limited to papers which support his theory.
2. His cases are too few in number to make any negative recommendation regarding the clinical suitability of anterior tympanotomy in cholesteatoma surgery.
3. His conclusion is one-sided and ignores data incompatible with his theory.
My opinion is that a new ventilation route between the eustachian tube and the epitympanomastoid cavity made by anterior tympanotomy is much more effective than the gas exchange via the mucous membrane for aeration of the postoperative tympano-mastoid cavity after cholesteatoma surgery.