[Surgical treatment of middle ear cholesteatoma. Open versus closed technique (author's transl)]

The preservation of the posterior bony canal in cholesteatoma surgery produces a rate of new cholesteatoma formation which constitutes a risk for the patients. The rate of recurrent cholesteatoma could be diminished from 19% to 4% by the consistent reconstruction of the lateral attic wall by endogenous conchal cartilage, even if the defects are very small. The rate of residual cholesteatoma could be reduced from 29% to 3% by improvement of the surgical technique (= wide exposition of the attic) and by an adaptation of the rate of radicals to the results of each individual operator. Each individual operator has to increase the rate of radicals as far as the rate of residual cholesteatoma diminished to a level which can be accepted. A strict long-term follow-up is necessary if the bony canal is to be preserved in cholesteatoma surgery.