Abstract
The management of cholesteatoma has been a controversial subject for many years. Advances in technology, magnification and surgical skills have enabled the otologist to deal more effectively with cholesteatoma over the years. However, attention must be paid to the pathological nature of cholesteatoma when planning surgical attack upon it. Rather than simply being skin that has gotten lost and becomes unable to cleanse itself of its epithelial debris, cholesteatoma is an invasive, erosive and destructive process. It feeds upon the bone by invading it with osteoclastic cells and others which are apparently capable of regenerating cholesteatoma matrix. Unless these residua are removed along with the matrix, one cannot be certain of total ablation of disease. Microscopic inspection at the operating table cannot be trusted to make this determination. Therefore, the case is presented for dealing with cholesteatoma in a two-stage operation. One-stage operations which reconstruct the ear at the same time as the removal of cholesteatoma matrix predispose to the recurrence of cholesteatoma in several ways. The neophyte otologist should not feel that extraordinary operations are the standard and should be prepared to utilize the basic mastoid operations as a preliminary to timed reconstruction of the middle ear. Observation of the ear over an interval is the best way to determine that cholesteatoma has been removed in its entirety.
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