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The article presents a method of surgical sanation of the protympanum cholesteatoma with simultaneous creation of additional aeration pathway of the middle ear and the mastoid process. This method involves atticotomy, removal of the incus and the head of the malleus, tenotomy of tensor muscle tensing tympanic membrane. After that, the falciform crest and cog are removed, and the fold of tensor tympani muscle is incised. To increase the diameter of the tympanal ostium of the auditory tube, the muscle tensing tympanic membrane with its bone canal is eliminated with its bone canal, as well as the shelf of protympanum lateral wall from the top to the tympanic ring, and protiniculum. Then cholesteatoma and the offending mucosa from protympanum are resected. During the sanitizing stage of the surgery, the microtopographic features of protimpanum are taken into account, which provides more detailed inspection, thereby reducing the chance of retaining the epidermal tissue in the tympanic cavity. The surgery is continued in the normal order: ossiculo- and myringoplasty are performed by autofascia. After that, a plastic surgery of the lateral wall is performed with a chondroperichondral flap. This method provides the sanation of protympanum cholesteatoma with the obstruction of the tympanal ostium of the auditory tube, to improve the patient’s hearing, and reduce the risk of development of residual and recurrent middle ear cholesteatoma.

Method of surgical sanation of protympanum cholesteatoma