Once the bony canal is drilled and the diseased TM remnant removed, the surgeon has a maximal view of the middle ear cleft. This allows thorough inspec-
tion of the middle ear and ossicles. Any disease (e.g., tympanosclerosis, cholesteatoma) is appropriately removed. Canal-wall-intact mastoidectomy and the facial recess approach are performed as necessary. Ossicular reconstruction, if indicated, is performed following placement of the temporalis graft.
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