[Trans-canal mastoidectomy].
The controversy regarding the best procedure for treating middle ear cholesteatoma has lasted over 100 years. This paper discusses our current methods for dealing with cholesteatoma, always through external ear or transmeatal mastoidectomy. We present the results of three years of follow-up.


METHODS
A prospective study was made of 215 ears operated for cholesteatoma using a transcanal approach with one of three techniques: "on demand" DAA mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy with obliteration. Three parameters were used to evaluate results: stability of the mastoid cavity, integrity of the neotympanum, and evolution of hearing.


RESULTS
The rate of cholesteatoma recurrence in ears operated with these techniques was much lower than that found in canal-wall-up techniques. Only 3 of the 215 cases (1.4%) remained unstable due to different causes three years after surgery.


CONCLUSIONS
Due to the high rate of cholesteatoma recurrence, canal-wall-up mastoidectomy has been abandoned in our clinic. Open techniques using a transmeatal approach, with or without obliteration, and the so-called "on demand" mastoidectomy, have yielded more stable results, although postoperative care is more critical.
Gómez-Ullate
R
R
Centro de Especialidades Quirúrgicas, Ciudad Universitaria, Madrid.
Cristóbal
F
F
Ruiz
C
C
Arcocha
A
A
Horna
J
J
D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D010036:Otolaryngology / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence