Clinical Results of Atticoantrotomy with Attic Reconstruction or Attic Obliteration for Patients with an Attic Cholesteatoma

Abstract

ObjectivesWe aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma.MethodsNinety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed.ResultsThere were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2±13.5 dB and 25.0±15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5±9.7 dB and 15.23±14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients.ConclusionAtticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.

Hearing results of tympanoplasty with attic reconstruction vs. obliteration in attic cholesteatoma

“…The collumela was placed directly on the stapes footplate. This is similar to the conclusion of the studies that observed the results of atticotomy to hearing and recurrence rate by Kim et al (1) and Gerhrking (2).…”

“…Lateral atticotomy provides safe approach to the lateral and upper attic space and bodies of the malleus and incus. In cases when the ossicular chain is still intact, the cholesteatoma sac can be removed from the lateral attic and the attic wall is reconstructed with one piece of 0.5 mm thick autologous cartilage (1,3,7). As anatomic conditions are restored almost completely, hearing results in terms of improving PTA and air-bone gap closure are the best.…”

“…Hearing improvement is a major factor in the assessment of the success of surgery for chronic otitis media. It could be achieved by meticulous reconstruction of the bony tympanic walls and ossicular chain at the same time (1). Attic cholesteatoma extends from the Prussack space in the lateral attic to the upper and medial.…”

Management and Surgical Outcomes in Patients With Chronic Suppurative Otitis Media

“…Холестеатома при хроническом гнойном сред-нем отите выявляется у 24-63% пациентов при любой локализации перфорации барабанной пе-репонки [5]. Стойкий санирующий эффект по-сле радикальных операций достигается лишь у 65-66% больных, а доля неудовлетворительных результатов продолжает оставаться довольно большой -от 10 до 15% [6][7][8].…”

The modern approaches to the treatment of chronic suppurative otitis with cholesteatoma

“…Именно поэтому в тече-ние последних лет появилась тенденция к сочетанию от-крытой и закрытой методик, т.е. к выполнению аттико-антро-мастоидотомии с облитерацией паратимпанальных пространств [6,[11][12][13]. Существует множество разных методик облитерации мастоидальной полости, аттика и адитуса: аутокостью, аутохрящом, фасцией височной мышцы, различными биологически инертными синтети-ческими и другими материалами [14,15].…”