Learning Objectives:

Introduction: The surgical technique in cholesteatoma is decided on the bases of the following criteria:

1.- Anatomical characteristics of the mastoid.

2.- Clinical type of cholesteatoma:

Congenital.

Primary acquired.

Secondary acquired.

3.- Surgical type of cholesteatoma:

Encapsulated and non-encapsulated.

4.- The estate of the mucose membrane.

Absent, cholesterol granuloma, polyps in the middle ear, etc.…

5.- Extension of the cholesteatoma.

Material and method: The above described criteria is revised in 380 consecutively operated. The different techniques and their results are described.

At present the most frequent technique is Intact Canal Wall tympanoplasty (210 ICW, 60%) followed by different types of Canal Wall Down (140 CWD 40%) tympanoplasties. In 350 (92%) a tympanoplasty was performed.

The incidence of Radical Mastoidectomies (RM), middle ear exclusion (MEE) and Subtotal petrosectomies (STP) are very infrequent (8%) and are performed mostly in revision surgery in cases with a failure of CWD tympanoplasty.

Results: The failures are subdivided in recurrent and residual cholesteatoma:

• • We have five percent of recurrent cholesteatoma in the adult and eight percent in children.

• • In 20% of the cases there is a residual cholesteatoma. Only 2% of them in CWD tympanoplasty, RM, MEE or STP.

The hearing results can be summarized saying that in 60% of the patients there is useful hearing without the need for a hearing aid. These results are closely related to the technique used for surgery.

Conclusions: Adequate selection of the surgical technique for each individual case is the first goal to obtain best results both to minimize recurrences and to obtain the best possible hearing results.

There is not a surgical technique that is best for all cases.

Diffusion MRI is very useful to follow cases of MEE and STP and has made us to indicate these techniques more often.