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[Conditions necessary for a cure of cholesteatomatous chronic otitis].

[Article in French]


The authors present a homogeneous series of 750 cholesteatomas treated surgically between 1973 and 1984, 710 cases by a closed technique (94%) and 40 by an open technique. After dealing with the false problem of the choice between open technique and closed technique, the authors attempt to define the conditions required for successful treatment of cholesteatomatous chronic otitis, and on that basis justify their own therapeutic attitude. Excision of the cholesteatoma must be complete and as a single block, from the periphery to the point of origin of the epidermal matrix. Such excision is possible in the majority of cases without damage to the bony canal walls. The risk of residual cholesteatoma fell from 19% in 1978 to 8% in 1984. The prevention of cholesteatoma is based upon our basic knowledge of the disease. It requires avoiding damage to or repair of the osteo-membranous anatomical barrier which separate the two compartments, outer and middle, of the ear. This aim can now be better achieved by the use of tympanic homografts and recent techniques for repair of the bony external auditory canal. Recurrences (13%) are due to the ability of progression of the cholesteatoma but also, and above all, the imperfect surgery. Whilst it was long believed that complete eradication of cholesteatoma was impossible without destruction of part of the architecture of the ear, it is now known to be possible, and even represents one of the best methods for the prevention of recurrences.

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