Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults.

Abstract

Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow-up of 24±12.2months, and the results of a CT-scan performed 1year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4%) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19±12.2 and 10±7.3dB pre-operatively and post-operatively, respectively (mean±SD, p=0.001, paired t test). Twenty-two patients (81%) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15%) presenting an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4%) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1year, and with closure of the air-bone gap by 50%.