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1. Cortical Mastoidectomy and
Combined Approach Tympanoplasty
(CAT)

2. Relevant Anatomy

3. Cortical Mastoidectomy

4. Combined Approach Tympanoplasty
( ie “canal wall up”, “intact canal wall”, “closed-cavity
tympanomastoidectomy”)
Reported Advantages
• Avoids open mastoidectomy cavity and its problems
• More physiologic and better for reconstruction of ossicular chain
• Allows an individual to go swimming

5. Disadvantages of CAT Surgery
1. Higher incidence of failure in literature.
2. Potentially dangerous in sclerotic mastoids.
3. Need for second look procedure (?)
4. Greater degree of surgical skill required.

6. Facial Recess Approach #1

7. Facial Recess Approach #2

8. Facial Recess Approach #3