A surgical solution for the difficult chronic ear.

We all encounter them: difficult chronic ears that seem to confound management efforts and that constitute an unrelenting imposition to the patient. Typically these ears have undergone multiple surgeries and are chronically infected. Such cases are commonly associated with residual or recurrent cholesteatoma. Those rare ears that temporarily respond to therapy promptly recur once treatment is withdrawn. Even the most aggressive nonsurgical protocols fail these patients, who exhibit lifelong social and professional incapacity. They seem to ultimately defy resolution. The purpose of this article is to present a surgical solution to the difficult chronic ear dilemma that emphasizes disease control. Treatment outcome is reviewed in 541 cases. Management pitfalls are analyzed with follow-up, in some cases 20 years.