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Cholesteatoma and Anterior Tympanotomy (Paperback, Softcover reprint of the original 1st ed. 1997)
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Cholesteatoma and Anterior Tympanotomy (Paperback, Softcover reprint of the original 1st ed. 1997)
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Acquired aural cholesteatoma poses a unique procedural dilemma with
regard to pathogenetic research and theory building. Because
cholesteatoma spontane ously occurs only in the poorly pneumatized
human ear, its pathogenesis is specific to humans. Nonetheless,
because of the ethical questions surrounding human experimentation,
pathogenetic study has almost exclusively involved nonhuman
subjects. Indeed, attempts have failed in almost all animal expe
riments except with the gerbil, and even here experimental designs
have been improbable compared with human cholesteatoma.
Cholesteatoma in the gerbil is useful, therefore, only for the
study of pathology and not for human pathogenesis. I hold that the
pathogenesis of cholesteatoma will be understood by studying the
cholesteatomatous ear, that is, the malpneumatized ear of the
human. The anatomical difference between the normal and
malpneumatized ear is a probable cause of cholesteatoma. This
difference may be found clinically in facial nerve decompression
and cholesteatoma surgery, as, for example, facial nerve palsy
occurs usually in the normal, well-pneumatized ear. Of course,
conventional animal experimentation will not confirm this clinical
difference since there is no ideal animal model for the poorly
pneumatized human ear. Present surgical techniques for
cholesteatoma vary greatly according to indi vidual otosurgeon's
opinion. The most extreme difference of opinion is focused on
whether to remove the external ear canal wall. Normally, the best
option would be not to remove the canal wall if cholesteatoma
recurrence can be prevented. Simply put, recurrence of
cholesteatoma comes about when its cause has not been removed
during primary surgery."
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