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Key Points

This article attempts to help clarify the anatomy of the regional, bulla and tympanic cavity and describe technical details to improve exposure while minimizing the risk of complication during and following LBO.

Regional anatomy of the tympanic bulla is complex and poorly exposed during surgery, and neurovascular damage during LBO can lead to acute life-threatening and/or serious long-standing complications.

Surgery to remove debris and abnormal epithelium within the tympanic cavity is indicated when medical therapy is either no longer effective, or when it is not likely to be successful, particularly when signs of chronicity (end-stage changes) exist on radiographic imaging of the bullae.

When epithelium and debris is seen extending into the tympanic cavity, the surgeon cannot feel confident that remote recesses of the cavity have been adequately debrided without aggressive LBO.

Incomplete evacuation of epithelium from the tympanic cavity has been implicated as the major cause of intractable deep-seated infection of the middle ear after TECA and LBO is performed for chronic end-stage otitis.