Basic principles of cholesteatoma surgery.

The behaviour of middle ear cholesteatoma appears to depend on the pathogen esis and the specific location of its origin. As well as the classical acqu ired form of cholesteatoma, we discuss subgroups such as the congenital for m of the disease, posttraumatic and external meatal cholesteatomas. The imp act that basic research has had on cholesteatoma surgery, the scientific kn owledge of tissue interactions and controversies on the reuse of ossicles a re presented and discussed. Available data on cholesteatoma epidemiology an d the possible influence of tubal function will be considered. The basic pr inciples of individualised cholesteatoma surgery are pointed out, specifica lly the treatment of the posterior canal wall and the surgical options avai lable depending on the site of predilection and the pneumatisation characte ristics. In general, the most important surgical principle of following the cholesteatoma epithelium is emphasised. Open-cavity surgery, treatment and replacement of the ossicular chain, the most frequently occurring mistakes and revision surgery are discussed. Complications such as exposed dura, la byrinthine fistula, exposed facial nerve, sinus thrombosis, extradural absc ess/subdural abscess, meningitis and brain abscess are presented. Specific problem areas in cholesteatoma surgery such as surgery in the only hearing ear or in the paediatric age group are also discussed.