Cholesteatoma surgery aims to achieve complete disease eradication while preserving or restoring middle ear function. Both canal wall up (CWU) and canal wall down (CWD) techniques are widely used, each with distinct advantages and limitations. CWU surgery offers the benefit of preserving normal anatomy but is associated with a higher risk of residual or recurrent disease. Incorporating mastoid obliteration into CWU procedures can reduce this risk and improve middle ear ventilation, while also eliminating the need for a second-look surgery in selected cases. In CWD surgery, mastoid obliteration has proven effective in minimizing the disadvantages of an open cavity—such as chronic discharge, vertigo with temperature changes, and the need for regular cleaning—while maintaining disease control. As such, mastoid obliteration has become an increasingly valuable adjunct in both CWU and CWD cholesteatoma surgery.

This instructional course will provide a comprehensive overview of mastoid obliteration in cholesteatoma surgery, focusing on its rationale, detailed surgical technique, and reported outcomes. Through a step-by-step video-based presentation, participants will gain insight into patient selection, choice of obliteration materials (autologous and synthetic), key surgical steps including disease clearance and reconstruction, and strategies to prevent complications.

The session will also present evidence from recent studies on long-term outcomes, hearing results, and quality of life metrics, with a comparison between obliterative and non-obliterative techniques.

Learning Objectives:

1. Understand the theoretical and clinical rationale for mastoid obliteration in cholesteatoma surgery.
2. Acquire knowledge of the technical aspects of various obliteration techniques.
3. Evaluate current evidence on surgical and functional outcomes to support clinical decision-making.