Transcanal Atticoaditotomy and Transcortical Mastoidectomy for Cholesteatoma: The Farrior-Olaizola Technique Revisited

Abstract

Conservative mastoid surgery in the management of middle ear cholesteatoma has been a subject of controversy for decades. Proponents of the combined-approach tympanoplasty for cholesteatoma do not entirely support the conservative approach in children, especially in the hands of an inexperienced surgeon. We describe here our experience with a modified technique of conservative mastoid surgery involving an atticoaditotomy and a separate simple mastoidectomy with lateral attic wall reconstruction (modified Farrior technique) that can be relatively safely used in the majority of cases of chronic squamous otitis media, even in children. This was a prospective analysis of the therapeutic effects and benefits of the technique used in 103 cases of cholesteatoma at Staffordshire General Hospital from 1991 to 1997. The follow-up was between 3 and 9 years. The study group consisted of 55 male patients and 48 female patients, including 28 children less than 16 years of age. The age ranges were 9 to 61 years in male patients and 10 to 48 years in female patients. After an audiological assessment, all patients underwent the described mastoid procedure, and some of them required revision surgery, mostly for a second look or for ossiculoplasty. The chief outcome measures used were complete eradication of disease, incidence of disease recurrence, and restoration of hearing. The steps of the procedure, its pros and cons, and the results of the series are presented. Also discussed is an overview of the literature pertaining to intact-canal wall mastoid surgery. Of the 103 patients, only 3 had a recurrence of disease, and 9 patients showed no hearing improvement. We conclude that this modified technique has several advantages over the previously described mastoidectomy procedures. It is a relatively simple and effective technique that can be performed even in children.

Follow-Up of Cholesteatoma Surgery: Open versus Closed Tympanoplasty

“…The choice of the technique for cholesteatoma surgery is mainly intraoperative, based on the propagation of the disease, Eustachian tube function, and the status of other middle ear structures (degree of pneumatization, changes of mucosa and ossicles) [8][9][10] .…”

“…The incidence of residual disease and retraction pocket is unequally estimated. Surgical results of attic cholesteatoma are worse in children; some even need a third-stage procedure, and frequently have to be treated with the canal wall-down technique in the subsequent operation [2,[10][11][12][13] .…”

Comparative Analysis of Effects of Reconstruction and Radical Treatment of the Posterior Ear Canal Wall Using Periosteal Osteocomma and Mastoid Antrum Ventilation

“…It was a huge challenge for no matter how experienced aurists to deal with middle ear cholesteatoma surgery on children or adult for decades [1]. Before 1950s, all of the operations were radical treatment or improved radical treatment.…”

“…Moreover, patients would usually be affected on their work and survivability with the very poor hearing. Therefore, some experienced aurists a designed new surgical method reserving the posterior ear canal wall [1,3,4], without postoperative radical cavity and with a satisfactory, longterm and ideal effect on hearing. As for the remaining radical cavity, there were constant measures designed to help patients to get rid of crusta and earwax easily accumulated and secondary infection, as well as adhesion of tympanum and tympanic membrane and serious hearing damages.…”

Intact Canal Wall Tympanomastoid Surgery: 10 Years Experience

“…Since the introduction of combined approach tympanoplasty (CAT), various modifications have been suggested by different otologists [2][3][4][5][6][7][8][9].…”