title: The operation of tympanomastoid re-aeration. Physiological repair of the radical mastoid cavity.
abstract: The aural cholesteatoma presents the triple problem of danger, discharge and deafness-a problem for many years answered by the classical radical surgery of the last century. The dissatisfaction with this approach has, however, been reflected in the various modifications that have recently culminated in the canal-conserving operation of the past decade or so. Gradually there has been a realization that the inherent, trouble-free stability of the normal healthy ear must be re-created before tympano-plastic repair of the hearing mechanism can be satisfactorily and indeed safely undertaken. This property of stability--the ability of the ear to "look after itself"--is dependent upon a natural environment for the constituent tissues that make up the sound conduction mechanism. Rational tympanoplastic surgery for aural cholesteatoma demands, therefore, both thorough disease excision and physiological reconstruction. This paper describes the priniciples and results of such a technique that I have used over the past ten years with increasing frequency. It combines the disease-excisive efficiency of the radical mastoid operation with a physiological rebuilding of the delicately balanced functional systems of the peripheral hearing mechanism.
mesh_terms: D002781:Cholesteatoma / Q000601:surgery; D004427:Ear Diseases / Q000601:surgery; D006085:Graft Survival; D006309:Hearing; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D008722:Methods; D013524:Surgical Flaps; D014433:Tympanoplasty / Q000379:methods*