[Techniques end results of surgical treatment cholesteatoma of middle ear]

Basic surgical techniques in the treatment of middle ear cholesteatoma include the intact-canal-wall and canal-wall-down tympanoplasty and combined method, i.e. the "mobile-bridge" tympanoplasty. The techniques including reconstruction of the posterior bone wall of the external auditory canal are combination of formerly mentioned methods. These tympanoplasty procedures involve a partial or complete removal of the posterior bone wall of the meatus. Subsequently, after the elimination of pathological process, the reconstruction of the middle ear is performed.

200 patients with middle ear cholesteatoma, who had undergone various microsurgical procedures, were monitored and evaluated in the period 1998-2006. The aim of this study was to present the main principles of tympanoplasty and outcomes of middle ear cholesteatoma surgery through a comparative analysis of the applied tympanoplasty techniques. The closed ICW and open CWD tympanoplasty were compared with the combined mobile-bridge technique with the reconstruction of the posterior bone wall of the external auditory canal.

The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques with radical trepanation of the temporal bone were 6% and 10%, respectively. In cases of combined mobile-bridge tympanoplasty with the reconstruction of the posterior bone wall of the auditory canal the incidence of residual cholesteatoma was 2%. The postoperative rejection of the replanted bone was observed in 2% of. the patients.

The selection of the appropriate surgical procedure is determined by the type and extent of pathological process, anatomic features of the pneumatic space of the middle ear, available microsurgical equipment and otosurgical skills of the surgeon.