Tympanoplasty: a 5-year review of results using the a la demanda (AAD) technique

The effectiveness of different surgical procedures to eradicate cholesteatoma in the middle ear was studied. The author reviewed 1405 cases conducted during 10 years (1974 to 1984) and found that the most important causes of failure are pocket cholesteatoma and residual cholesteatoma. With the goal of diminishing these factors, a la demanda (AAD) technique has been used for the past 5 years, with optimistic results--only 2.4% failures during this period. Other causes of failures have also been studied. The evolution of the surgical technique has had two orientations: to improve the results and to eliminate the failures. In the author's clinic there has been a percentage of failures, which has motivated an orientation toward more resolutive and destructive instead of conservative, techniques.