[The contralateral ear in cholesteatoma].

Cholesteatoma of the middle ear is bilateral in 10% of cases. Depending upon the ethnical characteristics or socio-economic levels, the frequency of cholesteatoma for a normal population varies from 1 in a 1,000 to 1 in 10,000. So, it becomes evident that the controlateral ear of cholesteatoma has to be considered at risk. The chances of seeing a cholesteatoma develop and particularly of observing the evolutionary stages are multiplied by 100 or 1,000! This report concerns the results of systematic examination of controlateral ear of 200 consecutive cholesteatomas, using binocular microscope and routine otoscopic photography. Eardrum was normal for 1/3 cases only. Modifications of the aspect of the tympanum related with active or sequellar lesions chronic otitis have been observed in all other cases. This finding leads us to the conclusion that cholesteatoma of the middle ear is related in the great majority of cases with the chronicle ear disease. Tubal insufficiency is of prime importance if we consider the high incidence of retractions pockets. Papillary invagination at the level of Shrapnell membrane is induced by chronical inflam-mation. Epithelial migration from the edges of a perforation is rare and only accidental. Clinical evaluation of the condition of the controlateral ear may also give indications about the background, the eustachian tube function and help for the choice of surgical technique radical or conservative.