The anterior hypotympanotomy is indicated for the removal of cholesteatoma primarily involving the hypotympanum and sinus tympani, which develop as a complication of adhesive otitis media or an atelectatic drum.1 As a result of the cholesteatoma removal and chronic eustachian tube dysfunction, the middle ear frequently heals with fibrosis, despite the best efforts to preserve a middle ear air space. Following a hypotympanotomy, the middle ear
FIGURE 7-6 (A) The cholesteatoma and ossicular chain are exposed in the epitympanum with the removal of the lateral attic wall. (B) Note the anterior and posterior bony buttresses, which will support the bone flap or cartilage graft after removal of the cholesteatoma.
space frequently collapses resulting in a significant conductive hearing loss. Therefore, recurrent or chronic infection, not the need for hearing improvement, should be the primary indication for this procedure.3
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