Abstract
Cholesteatoma is a common otologic destructive process that involves the middle ear and mastoid. Biologically, hallmarks of cholesteatoma, specifically invasiveness, unrestrained proliferation, aggressiveness, and recidivism, suggest a fundamental alteration in the normal biology of one or more of the cellular constituents that comprise cholesteatoma, ie, fibroblasts and keratinocytes. The contemporary otologic surgeon may rely on a variety of therapeutic options to treat this serious disease. The otologic surgeon has the option of using one of several operative approaches to treat cholesteatoma. These procedures may be divided into two broad categories. One is a canal wall up (CWU), in which an air-containing mastoid and an external ear canal are preserved. The second category is canal wall down (CWD), in which the posterior canal wall is removed and the mastoid marsupialized into the enlarged ear canal. The primary goal of the surgical treatment of chronic mastoiditis due to cholesteatoma is its complete eradication in order to provide the patient with a safe, dry ear. An important but secondary goal is to improve or preserve the hearing acuity by restoring an aerated middle ear cleft and reconstructing the tympanic membrane and the ossicular mechanism. An additional goal is to minimize the need for long-term care of the operated ear. The surgeons on the program present varying views on how this can best be accomplished. Management of cholesteatoma remains controversial. Areas of controversy include assessment of the tubal function, preoperative care of the cholesteatomatous ear, selection of operative technique for a specific patient, mastoid obliteration, single or staged procedure, immediate versus delayed hearing reconstruction, radiologic follow-up versus surgical re-exploration, use of endoscopes, and facial nerve monitoring. The miniseminar's format will be that of an interactive panel that will discuss the biology, evaluation, and management of patients with cholesteatoma in a case presentation format. Experienced otologic surgeons will discuss advantages and disadvantages of different operative techniques and will present their philosophy of cholesteatoma management and follow-up.