Rational approach for managing cholesteatoma

抄録

The rational treatment for the cholesteatoma should be based on the factors related with the pathogenesis, behaviors, localization of the cholesteatoma as well as the anatomic and functional factors and the ossicular chain involvement.
1. Retraction pockets are known to be the precursors of cholesteatoma formation so the retraction pockets in earlier stages have to be strategically treated.
2. The impairment of ventilation between the Eustachian tube and the aditus is very important in the pathogenesis of retraction pocket formation so, maintaining or re-creating the pathways again will serve for better success.
3. The surgical plans should be based on the locations of the cholesteatoma in order to have a beater exposition of the cholesteatoma and to remove it completely.
4. It is important to establish the most efficient way of reaching to the cholesteatoma even if it is located in tympanic sinus or anterior epitympanic recess. May be the endoscopes can serve us for better control in these cases.
5. One of the most important factors on determining for the type of surgery is the presence of mastoid air cells. The sclerotic mastoids as being the evidence of impaired ventilation should force us for creating small cavities in common with the middle ear and external auditory canal. But the most important is preserving he mucosa which is known as the lungs for the middle ear.
In regard to the factors mentioned above, the strategies of performing open and closed techniques will be discussed as well as the preventive measures of residual and recurrent cholesteatoma.