Open mastoid procedures: contemporary indications and surgical technique.

The history of the management of chronic ear disease with and without cholesteatoma is dominated by a canal wall down philosophy. The implication is that such an open procedure insures disease control and an uncomplicated future. In point of fact, problem canal wall down procedures can be fraught with as many serious complications as their more controversial canal wall up counterpart is alleged to propagate. Such problem cavities most commonly result from poor execution of basic technique. The objective of this paper is to identify what constitutes a problem cavity and to describe the authors' techniques to avoid such difficulties. A technique has evolved which not only eradicates disease, but which is self-cleansing and of minimal impact on the patient's lifestyle. The authors' experience with canal wall down procedures is reviewed.