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.
Introduction Glomus tumors are rare benign neoplasms in the head and neck. Glomus tympanicum and glomus jugulare lesions are associated with the temporal bone. The usual presenting symptom is pulsatile tinnitus followed by hearing loss. There is no controversy with the management of glomus tympanicums as they are mainly treated with surgical removal. Controversy occurs in the management of glomus jugulare tumors because of the lower cranial morbidity associated with the surgical removal. Materials and Methods Glomus tympanicum and jugulare cases will be discussed. Work up and therapeutic management will be reviewed. In glomus jugulare cases, conventional surgery verses gamma knife stereotactic radiation will be discussed. Outcomes and complications will be reviewed. Results Glomus tympanicums respond well to surgical excision. Glomus jugulare surgery is commonly associated with dysphonia and dysphagia. Patients commonly require a short term feeding tube because of the risk of aspiration. While stereotactic radiation does prevent further growth of the lesion, it does not correct the pulsatile tinnitus or conductive hearing loss as well as surgical excision. Conclusion There appears to be significantly higher morbidity with surgery verses stereotactic radiation. Patients should be counseled appropriately, especially about the cranial nerve deficits. Also, they should express realistic expectations of the results particularly the resolution of the tinnitus and hearing loss.