Learning Objectives: We have performed canal-wall-down tympanoplasty reconstruction with soft posterior meatal wall for cholesteatoma as a single-stage operation from 1998 to 2009. Although this method designed to prevent a cholesteatoma recurrence, posterior meatal wall often retracts like balloon similar to that of conventional open method operation and it has sometimes caused cavity problems, in long-term follow-up.

As you know, in approximately 80% of an anterior attic bony plate of pars flaccida is closed in cholesteatoma cases. As results ventilation routes from Eustachian tube to epitympanum and mastoid antrum are hard to be formed by the single staged operation.

Therefore, after 2010, we decided to perform thinly sliced cartilage technique in a canal-wall-up procedure with planned staged tympanoplasty in many cases.

Cartilage is used as perichondrium-cartilage island flap, and it includes treatment and prevention of attic retraction, reconstruction of scutum and reconstruction of tympanic membrane. This cartilage is the size enough to reconstruct scutum and an eardrum by one. The island flap is simple to use more than a way using both of a cartilage and a fascia. Because it's possible to reconstruct superior and posterior wall of EAM by one operative procedure.