Improvement of the surgical technique of anterior tympanoplasty in cholesteatoma

Technical improvements in anterior tympanotomy with a transmastoid approach in cholesteatoma surgery are reported. Mastoidectomy must be extended to the root of the zygoma and the space anterior to the malleus head must be opened. For this purpose, the visual axis must coincide with the external meatal axis. In this head position, complete removal of the anterior attic bony plate becomes possible only through the transmastoid approach, without touching the ossicular chain. In the case of the pyramidal type bony plate with a normal ossicular chain, the incudo-malleal joint is temporary subluxated, as this is more convenient for access and removal of pathology than incudostapedial joint subluxation. Our clinical results on postoperative hearing showed no damage to the inner ear by the improved technique.