A review of current progress in acquired cholesteatoma management.

The aim of this study was to review recent advances in the management of acquired cholesteatoma. All papers referring to acquired cholesteatoma management were identified in Medline via OVID (1948 to December 2013), PubMed (to December 2013), and Cochrane Library (to December 2013). A total of 86 papers were included in the review. Cholesteatoma surgery can be approached using either a canal wall up (CWU) or canal wall down (CWD) mastoidectomy with or without reconstruction of the middle ear cleft. In recent decades, a variety of surgical modifications have been developed including various "synthesis" techniques that combine the merits of CWU and CWD. The application of transcanal endoscopy has also recently gained popularity; however, difficulties associated with this approach remain, such as the need for one-handed surgery, the inability to provide continuous irrigation/suction, and limitations regarding endoscopic accessibility to the mastoid cavity. Additionally, several recent studies have reported successes in the application of laser-assisted cholesteatoma surgery, which overcomes the conflicting goals of eradicating disease and the preservation of hearing. Nevertheless, the risk of residual disease remains a challenge. Each of the techniques examined in this study presents pros and cons regarding final outcomes, such that any pronouncements regarding the superiority of one technique over another cannot yet be made. Flexibility in the selection of surgical methods according to the context of individual cases is essential in optimizing the outcomes.