Pathogenesis of cholesteatoma based on clinical results of anterior tympanotomy.

A new conception of the pathogenesis of cholesteatoma is proposed based on clinical results of anterior tympanotomy, a procedure developed in order to prevent recurrence of cholesteatoma following retraction pocket formation after canal-up operation. In the cholesteatomatous ear, there is always a long, thick bony septum between the epitympanum and the supratubal recess. This septum is called the anterior attic bony plate, forming the tympanic diaphragm together with the tensor tympani mucosal fold. In anterior tympanotomy, this bony plate is removed finishing intact canal wall mastoidectomy, making a new ventilating route to the eustachian tube. With this technique, the rate of recurrence was reduced from 17 to 5%. Based on these results it is proposed that the real pathogenesis of cholesteatoma is not tubal dysfunction, but the osseous tympanic diaphragm.