! " # $ $ ! % &$ ' ( )* +&, *- ! "# ! $% . /0 '112 :: 2 *3 : < /** /) : : D *3 : : I 3 /) : : 22 &/3* : 2< )4* *53 : 2D 4 *3 : 2J * 6* : 2I /* ** : 32 5 * : : 3< * : : 3D + */*3 * : 3I : : <2 ))57 : << 8 : <D DEDICATORIA A mis padres por su apoyo en el inicio de la carrera médica. A mi esposa por su tenacidad y dedicación. A mi hijo por ser el motor de mi superación &'( )*+,+ - . /0+ +1 & 2 ! " # $ $ ! % &$ ' ( 3 &'( )*+,+ - . /0+ +1 & *3 *3 ' /(41 1 ++ +*++ /15 5 + '++ 1 + +/+ 4*,/+ /( ,5+ +/ +6 *, +* + 1 ' /1 (,1 7,4',/! + ,151/,81 7,4',/ 1 ,/0+ /,1+ /,,5 19(6 + /, 15 +1/, 9/,81 ,(:1,/ 5 1 () (, '+ 1 /18(,/ /( +/, /(+ /( 1 19( /1 1 91 ,+//,1! (,5 9,1, +1 +,+ + (,1 + 9/+ +/,+ /,,5 1 /,1+ +6 / 1+ (,,: 1+ 1 /1 1 9+ ,151/,1+ 7,4',/+ +* 7+ /,1+ 7 + ,15,11 ,( 5;6 /151 1 ,+(,1/,81 1 + /++ 0+,,+ ) ,1//,81 /,1 +/ /,5! &'( )*+,+ - . /0+ +1 & < ! " # $ $ ! % &$ ' ( = &'( )*+,+ - . /0+ +1 & /** /) /** /) ,,+ (, /81,/ + //,; +1 1 9/,81 ,(:1,/ (11 ) /,1+ /81,/+ (/+ (,! 0* ,1(,1 /1,1 0,/+, ,+,1 '! 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" # $ $ ! % &$ ' ( A &'( )*+,+ - . /0+ +1 & *3 *3 + (+,+ + 19( 1 '1 +1 ( 5+ /,16 7 + +*5! + 9/1+ ,+ 1 +1 ,1+ ) +1 /1+,+ /( &1(+&! 0,/+, + ,1+/,81 1 ) 5/+ + () +,'1,9,/,5! 1(1 + 1, C,+1 1(++ /++ 1 7 + *,! C(1 9+,/ /,1 1: ((1 1 7 + ,;! 1 , /,5 @/1/ ,,5 C1B + 1/1: / +//,81 16 5/+ ( ! 1 , ,1/,5 + /,: (> , 9/,81 ) + //+,/+ (/+ (,! 9/,81 + (E 5,*! 1 /+,1+ (1 :/,/(1 0 +/,! (/+ + 1( *,1 (+ ) 1>/,! + ,+ /,5, (/0+ 5/+ ,15/,11 +1:1(1 +E1 9+(1 (> /! 9,+,' + 19( / /+1 1 19( , ) 1 1 7 5/,18 1 ! ;81 / ,19//,81 5/,1 ,1(,(1 1 '+,81 1 + /6 + ,15/1 ;1+ , ,1(18',/+! +/ ,19//,81 ,(, + 9/,81 ) +,(1 ,19//,81 1 9/,81 , ( +7,!@J632B / /1,/ '1(1 + +1 + (1+! +,( /1 9/,81 ,(:1,/ ) /> /1 /+ /,1+# ) 9( /+(+ @(:+ '5B 1 1 C,+1 +,1+ +,/+ 7 51 +)1 >, 8+ 9(1 8,+ ) 9(/,81 ,15+,81 , 1 (, &'( )*+,+ - . /0+ +1 & I ! " # $ $ ! % &$ ' ( @/+(B! /+( + ,',1 //,(,1 , 1 (, @/+( +/1,B *,1 //,81 1 /,81 ((*1 ,(:1,/ ) +, 5/,81 @/+( ,(,B! C,+ 1 / 9( /+( 7 + /1'?1, ) 7 + / 1 1 /1 (1 +1 ) /) '?1+,+ + C,/ ++ (*,1,+ , 1 (,! 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achín V, Benito I, Vieieto R, Ortiz M. Cirugía Radical conservadora en la OMC. Rev. Cubana Cir 1999;38(1):11-15. Sardon J. Evaluación de las Secuelas Funcionales y Recidiva Post Operatoria de la Técnica Quirúrgica de Cavidad Cerrada para el Colesteatoma en Pacientes que acuden al Hospital Militar Central de Lima. Enero de 1990 – Abril del 2000. Rev. Universitas 2001;3:114-118. Gil Carcedo LM. Otología. Barcelona: Vila Salas Hnos;1995:307-30. Deguine C. Staging in cholesteatoma surgery. Ear-Nose-Throat J 1993;72(3):197-200. Helms J. Moderns aspect of tympanoplasty. An overview. Laryngorhinolog 1995;74(8):465-7. Saunders JE, Schoemaker DI, Mc Elveen JT. Reconstruction of the radical mastoid. Am J Otol 1992;13(5): 465-9. Sanna M, Shea CM, Camoletti R, Russo A. Surgery of the &laquo;only hearing ear&raquo; with chronic ear disease. J Laryngol-Otol 1992;106(9):793-8. Paparella MM, Jung TK. Intact bridge tympanomastoidectomy. Combining essential features of open vs closed procedures. J Laryngol Otol 1987;97(7)579-85. Echeverría M, Olarieta M, Álvarez de Cazar F. Causas de fracasos en la cirugía radical de las mastoides. Acta Otorrinolaringol Esp 1989;40(3):181-4. Brook I. Management of chronic suppurative otitis media. Pediatr Infect Dis J &'( )*+,+ - . /0+ +1 & << ! " # $ $ ! % &$ ' ( 1994;13:188-93. Bárbara M, Modesti A, Caggialy A, Saliola S, Filipo R. Effect of intraoperative manipulation and preservation on fascia temporales used in tympanoplasty. Acta Otorrinolaryngol-Belg 1993;47(1):11-6. Vartiainen E, Nuutinen J. Long-term hearing results of one-stage tympanoplasty for chronic otitis media. Eur Arch Otorrinolaryngol 1992;249(6):329-31. Machín V, Vieito R, Benito I, Freyre J. Miringoplastia. Resultados anatomofuncionales. Rev Cubana Cir 1997;36(1):6-12. Alonso A. Éxito del método quirúrgico para la eliminación del colesteatoma. Acta Otorrinolaringol Esp 2001;52:304-307. Ferrer MJ. ¿Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura. Acta Otorrinolaringol Esp 2002; 53: 14-18. Rodriguez M, Ganez E, Castro A. Colesteatoma gigante a tímpano cerrado. Acta Otorrinolaringol Esp 2001; 52: 147-149. Charles M, Luetje MD. F.A.C.S. Draining mastoid cavity. Current Therapy in Otolaringology-Head and Neck Surgery 1995, 25-27. Vincent N. Carrasco and Harold C. Pillsbury III. Revision mastoidectomy. In: Vincent N. Carrasco, Harold C. Pillsbury III. Revision otologic surgery 1997. Nadol JB. Causes of failure of mastoidectomy for chronic otitis media. Laringoscope 1995; 15: 410-413. Pillsbury HC, Carrasco VN. Revision mastoidectomy. Arch Otolaryngol Head Neck Surg 1990;116:1019-1022. Youngs R. The histopathology of mastoid cavities, with particular reference to persistent disease leading to chronic otorrhea. Clin Otolaryngol 1992; 17:505-510. Sam E, Kinney MD. Chronic draining ear. Current Therapy in Otolaryngology-Head and Neck Surgery 1995,18-20. Sheehy JL. Cholesteatoma surgery: canal wall down procedures. Ann Otol Rhinol Laryngol 1988; 97: 30-35. Osborne JE, Terry RM, Gandhi AG. Large meatoplasty technique for mastoid cavities. Clin Otolaryngol 1985; 10: 357-360. <= &'( )*+,+ - . /0+ +1 & 8 8 /* 5 N!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!O!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !. $P 2! @!!!B ,/+, @!!!B $?,' @!!!B :,+,+ 9/, @!!!B + 1/1+ 3! ! ( @!!!B '1+, @!!!B &'( )*+,+ - . /0+ +1 & <D ! " # $ $ ! % &$ ' ( +1+,+ @!!!B C++,+ @!!!B + *! (*1 ,(:1,/ QR ( +/+,+ /+, 9/,81 + /! > ,(:1,/ /!2! + (/+ ( @!!!B ,*+,+ @!!!B 8,+ @!!!B ( @ B 1(+ @!!!B //,1+ @!!!B + <!O Q =! D! F!O 3!. $ !. (*1 ,(:1,/ ( +/+,+ /+, 9/,81 + *!. > ,(:1,/ *!2! + (/+ ( @!!!B ,*+,+ @!!!B <F &'( )*+,+ - . /0+ +1 & 8 8,+ @!!!B ( @!!!B 1(+ @!!!B //,1+ @!!!B + /!. 1 +/,/ !. ( +7, !. + ?/1,/ R,4',/ , 1> <!. $ < J 2D % $ & * +C 1+/,81 +* (' 1 */ ,9,/, *:,/ 1 /> ,(:1,/ 15, 9/, 5, ,(:1,/ 1( +, > /1 0+ 1 >, (/+.'1(+ E+ /(,+ (+/,1 @2B 9(1,1 @3B 1(,1 +, @2B 1 @3B ;81 1(,1 *+, @2B ,* @3B 1(,1 5 @2B *,/ @2B +/0 @2B + @2B 1(,1 1(,1 1(,1 1(,1 *> @3B ,+ @3B (, @3B 9+ @3B +, @2B 1 @3B +1 @2B +1 @3B &'( )*+,+ - . /0+ +1 & 1(,1 1(,1 <J