These initial steps are carried out in all cases. Once the middle ear is well exposed, the decision about which type of tympanoplasty technique to use (over-under, underlay, or overlay) is made. Indications for the over-under tympanoplasty technique are outlined in Table 5-1.
Middle ear cholesteatoma, granulation tissue, diseased mucosa, and so forth are dealt with at this time. If a mastoidectomy is required to remove tissue safely from the middle ear or if there is disease in the mastoid, then an intact canal mastoidectomy with facial recess approach is employed. Further
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