Learning Objectives: Video presentation on the technique of using bone pate and Cortical bone chips for reconstructing the cavity in recidivistic cholesteatoma.

Introduction: Recidivistic cholesteatoma presents a serious surgical challenge. The demands to the surgical team is high- we are supposed to remove disease, improve hearing and give a dry, self cleansing ear. At our institute where we deal with a large amount of recidivistic cholesteatomas, the bone obliteration technique with scar tissue graft has helped us to give a fair result to most of our patients. The video demonstration is designed to give a step by step demonstration of the technique used in over a hundred cases over the past four years.

Methods: The case series is from a tertiary care otologic center in South India, all operated by a single surgeon, under general anesthesia. Standard post auricular method is adopted, with harvesting of the scar tissue graft intially, bone chips from the cortical bone and collection of bone pate by an indigenously developed apparatus. After a complete canal wall down mastoidectomy and removal of disease, the cavity is obliterated with bone pate mixed with antibiotic solution, and covered with the cortical bone chip carefully harvested. The middle ear is reconstructed with cartilage and grafted over with the dried and thinned out scar tissue. Ossiculoplasty is either performed at the same sitting or staged according to the disease.

Results: We have achieved the objectives of a dry, self cleansing mastoid cavity in a large majority of cases with acceptable hearing. Hearing results have been poor where the stapes superstructure was absent where staged ossiculoplasty was often performed. The number of post operative visits also were minimal with this technique.

Conclusions: The bone obliteration technique combined with scar tissue and cartilage grafting saves time and effort in giving a dry and clean ear after recidivism. Most of the problems in a wet mastoid cavity are solved with this technique.

Learning Objectives: the video presentation gives a clear demonstration of the techique to be adopted by surgeons handling recidivism.