Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively. Drilling through a sclerotic and small mastoid cavity, keeping the canal wall intactis often difficult and increases the risk of serious injury. Consequently, a canal-wall-down mastoidectomy is often performed. The endoscopic transcanal modified canal-wall-down mastoidectomy approach allows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.
Keywords: Attic obstruction; Attico-antrotomy; Cartilage repair of attic; Cholesteatoma; DWI MRI; Inside-out technique; Middle ear cholesteatoma; Ossicular chain reconstruction; Propeller MRI for cholesteatoma; Sclerotic mastoid.