Anterior Tympanotomy: A Surgical Technique for Cholesteatoma

Abstract

Surgery for cholesteatoma began with radical operations and then conservative radical operations were developed. After proposal of the so-called canal-up technique for chronic otitis media in the 1960s, this technique was used with great expectations even for cholesteatoma. In particular, Jansen’s (1967) posterior tympanotomy technique and Sheehy’s “intact canal wall” technique (Sheehy and Patterson 1967) have tended to the so-called canal-up or “closed” techniques. During the latter half of the 1970s, however, an increasing number of adverse reports began to appear that revealed alarmingly high incidences of both recurrent and residual cholesteatoma. Thus, many improved techniques were presented such as the mastoid obliteration technique (Palva 1973), the combined approach tympanoplasty (Smyth 1976; Sade 1982), osteoplastic epitympanotomy (Wullstein 1974), the canal-down with reconstruction technique (Suzuki, 1982), the lateral tympanotomy technique (Tos 1982; Bhide 1982), and so on. No reliable technique has been reported, however, that makes use of a canal-up method in an operative procedure for cholesteatoma for general use by otologic surgeons.