Hetzler DG., Otol Neurotol. doi: 10.1097/MAO.0000000000001383. [Epub ahead of print], 2017 Mar 22
Patient's perspective is lacking in Grinblat's paper. For some, decline in high frequency hearing due to drill noise is undesirable.
Based on 18 years of experience, with proper instruments and technique, the use of 1 mm osteotomes transcanal more readily preserves the ear canal skin and its blood supply; the 1 mm osteotome is well suited to cleaving the bone growths along natural cleavage planes; and the noise associated with using osteotomes is negligible.
Some of the disadvantages of a transcanal osteotome technique are that most otologists do not have the proper instrumentation or experience in using the instrumentation.