Canal wall up tympanoplasty: prevention of cholesteatoma recurrence following postoperative retraction pocket

The ideal surgical treatment for middle ear cholesteatoma is to create a re-pneumatized middle ear cavity from the Eustachian tube to the mastoidectomy cavity. The canal wall up technique is advantageous in this regard although its reliability for the prevention of cholesteatoma recurrences has always been subject to controversy. This paper describes the surgical concepts to create a communication route from the protympanum to the attic by widening the tympanic isthmus with anterior tympanotomy. Removal of the incus and the head of the malleus helps to maintain its patency in ears with a poorly developed supratubal recess. Erosion of the scutum should be repaired using autologous cartilage. We apply staging operation with placement of silicon sheeting in the middle ear space in ears with irreversibly diseased or absent middle ear mucosa.