If the disease is difficult to remove, so that there is an increased risk of residual disease, then removal of involved ossicles in order to fully clear cholesteatoma has generally been regarded as necessary and reasonable. In other words, the aims of cholesteatoma treatment form a hierarchy. The paramount objective is the complete removal of cholesteatoma. The remaining objectives, such as hearing preservation, are subordinate to the need for complete removal of cholesteatoma. This hierarchy of aims has led to the development of a wide range of strategies for the treatment of cholesteatoma. Surgery
The variation in technique in cholesteatoma surgery results from each surgeons judgment whether to retain or remove certain structures housed within the temporal bone in order to facilitate the removal of cholesteatoma. This typically involves some form of mastoidectomy which may or may not involve removing the posterior ear canal wall and the ossicles. Removal of the canal wall facilitates the complete clearance of cholesteatoma from the temporal bone in three ways: 

It removes a large surface onto which cholesteatoma may be adherent;
It removes a barrier behind which the cholesteatoma may be hidden;
It removes an impediment to the introduction of instruments used for the removal of cholesteatoma.Thus removal of the canal wall provides one of the most effective strategies for achieving the primary aim of cholesteatoma surgery, the complete removal of cholesteatoma. However, there is a trade-off, since the functional impact of canal wall removal is also important.
Although more studies are needed, so far, new techniques addressing underlying Eustachian tube dysfunction such as transtympanic dilatation of the Eustachian tube has not been shown to change outcomes of chronic ear surgery. Infections
Recent findings indicate that the keratinizing squamous epithelium of the middle ear could be subjected to human papillomavirus infection. Indeed, DNA belonging to oncogenic HPV16 has been detected in cholesteatoma tissues, thereby underlining that keratinizing squamous epithelia could potentially be a target tissue for HPV infection. Epidemiology
In one study, the number of new cases of cholesteatoma in Iowa was estimated in 1975–76 to be just under one new case per 10,000 citizens per year. Cholesteatoma affects all age groups, from infants through to the elderly. The peak incidence occurs in the second decade. See also
Chronic suppurative otitis media
Otic polyp
Endoscopic ear surgery

References
External links

Information on Cholesteatomas
Laser Cholesteatoma Surgery