Abstract
the treatment of cholesteatoma employing intact canal wall tympanoplasty, staging the operation isrequired to re-establish aeration of the tympanic cavity and to eradicate possible causes of recurrence, cholesteatoma residue, and retraction pocket. The planned staged tympanoplasty with preventive measuresfor recurrence has evolved. The first stage operation is carried out to remove cholesteatoma, to controlinflammation, and to reestablish well aerated middle ear. Posterior tympanotomy with removal of the incusand head of the malleus allows wide view enough to remove the cholesteatoma under an operation microscope.For safe and total removal oto-endoscopy is of great help. The new methods of silastic sheeting and amastoid cortex plasty are described. Scutum defect must be repaired using bone pate. The second stageoperation is performed between 9 and 12 months after the first stage operation. At the second-stage operation, one of the following three types of operations was performed according to the finding of the middle ear: type S-I ; ossiculoplasty and mastoid cortex plasty, type S-II; ossiculoplasty, scutum plasty and mastoid cortexplasty and type S-III; ossiculoplasty, scutum plasty, and mastoid obliteration. The type S-I operation isindicated for an ear with a perfectly aerated middle ear lined with normal mucosa and without a defectivetympanic scute. The type S-II operation is indicated for an ear with a defective tympanic scute, but a partiallyaerated middle ear. The type S-III operation is indicated for an ear with a poorly aerated middle ear cavityand a defective tympanic scute. The surgical concept, indication, and technique are briefly describedtogether with the long-term results.
