Cholesteatoma in the petrous apex

Six patients with extensive cholesteatoma in the petrous pyramid are reported. All patients had a facial palsy of long duration. In five patients with a history of otitis media, radiographic examinations and surgical explorations revealed chronic inflammatory changes in the middle ear, which suggested that the cholesteatoma in the petrous pyramid was associated with a preceding otitis media. Only in one patient, without a past history of otitis media, was the cholesteatoma assumed to be of congenital origin. The cholesteatoma was totally removed in five patients using a translabyrinthine approach and in one by a middle cranial fossa approach. Control of middle ear infection, obliteration of the mastoid petrosal cavity, and facial nerve repair were supplementary but significant surgical problems.