If this is not possible, we prefer
Kerrison rongeurs to begin bone removal ventral to the
stylomastoid foramen just caudal to the EAM (Figure 8).
Bone is very brittle and hard in this area, but once the
shelf and bone just caudal to the EAM have been
removed, the remaining caudal bulla bone is usually thinner
and easier to excise (Lempert rongeurs will suffice
here). Do not attempt to rongeur bone rostrally becausestructures of the epitympanic recess could be damaged and
the retroarticular vein may be torn. The retroarticular vein
cannot be exposed readily and is usually not evident to the
surgeon unless it is damaged. If brisk hemorrhage is
encountered in the rostral aspect of the EAM, use a cotton-
tipped swab and apply pressure to the origin of the
bleeding area.