[Reflections on cholesteatoma].

Cholesteatoma, defined by Muller in 1830, has not benefited by any means to the same extent as other otological conditions from therapeutic progress. Its histological nature has been defined on information supplied by the electric microscope. It remains puzzling and the manner in which it invades the inner ear cavities imperfectly reproducing the epidermis remains very much a mystery. In spite of a certain ultra-structural unity, it would appear that there is not just one, but many cholesteatomas and if this protean condition is to be understood treated, a primary requisite is a nosological break-down which takes into account the topography of the lesions and their macroscopic appearance. From this attempt at a classification which groups together the most frequently encountered possibilities, operative indications which have to take into account several contradictory preoccupations can be arrived at. It is essential to: -- eradicate the lesions as thoroughly as possible; -- avoid damaging those structures of the middle ear which are still functional or which may be made serviceable again; -- leave open the possibility of surveillance of the cavities so as to detect relapses. These contradictory requisites can be reconciled in a great number of cases and justify the hope that a cure will go hand in hand with an appreciable gain in function. As examples, a few audiograms of patients operated on are included to show the sort of results that it is possible to obtain.