Transcanal management of benign middle ear lesions involving the anterior middle ear cleft

The anterior middle ear has always been a difficult area to visualize and access. This report reviews the experience with a new approach to gain exposure of the middle ear. This technique involves separating the entire pars flaccida from the handle of the malleus for better exposure and then replacing the drum. Four patients were treated in this fashion; one glomus tympanicum, two congenital cholesteatomas, and one benign adenoma. All patients benefited from improved exposure and resection. No patients had postoperative laterialization of the drum and hearing was maintained.