Learning Objectives:

Introduction: most of large cholesteatomas have been done by Canal Wal Down (CWD) Tympano mastoidectomy. The problem is wet ear, a large ear canal or mastoid cavity, hearing gain, recurrency or recidief problems.

Objective: to introduce a new technique of Posterior Canal Wall(PCW) have been reconstructed by using skin musculo periosteal flap on CWD Tympano-mastoidectomy. Normal ear canal size, dry , less recurrency or recidief and hearing gain be achieved.

Methode: during 2010–2014(5 years) among 752 ear surgery has been done reconcontruction PCW on 67 ears during CWD Tympano-mastoidectomy as simultaneously surgery . The age of patient among 5- 73 years old, most among 20–40 years old . Soft connective tissue that is skin musculo periosteum have been use as material of PCW.

The middle ear such as ossiiculoplasty be done by cartilage autograft or polymers teflon prostheses. This technique be classified as closed technique on management of cholesteatomas Chronic Otitis Media.

Result: most cases dry ear 3–4 weeks after surgery, ear canal on normal size , depands of the foot plate stapes movement and the audiogram pre- operative, hearing gain was 0–30 dB.

Complication: infection be founded 2 cases and can be cure by oral antibiotic untill 4 month after surgery. Recurrent 2 cases be revisioned by endoscopic middle ear surgery.

Conclusion: Recontruction PCW by using skin musculo periosteum is better as an new technique surgery for to get normal ear on CWD tympano mastoidectomy.