Attic Wall Research Articles

An Observational Study to Assess the Outcome of Canal Wall Window Tympanomastoidectomy in Chronic Suppurative Otitis Media.

This study was undertaken to assess the outcome of canal wall window tympanomastoidectomy in chronic suppurative otitis media in a tertiary care centre of central India. A total of 50 patients were taken for this study in which the youngest patient was 13-year-old male and oldest 55-year female. Maximum patients were in between age group 10 to 20 years, 20 (40%) patients and minimum 03 (6%) between age group 51 to 60 year. The study mainly emphasized on: To study the clinical profile of the cases of chronic suppurative otitis media, to study the hearing outcome after 3 months of Canal wall window tympanomastoidectomy technique, to study the post-operative condition of ear after 3 months whether dry or wet and to study the post-operative follow up of cases to assess the graft uptake. Average PTA & ABG improvement of different tympanoplasty was also calculated in our study in which Type I tympanoplasty had 12.20dB gain, Type II of 10.50 and Type III of 10.31dB.An overall average improvement in all patients with tympanoplasty was 11.00dB.At the end of the study 100% dry ears were achieved. The technique of canal wall window tympanomastoidectomy involves formation of a window in the outer attic wall to look at the disease extent which was then closed by a snuggly fitting cartilage.It is a novel technique & without compromising the structural integrity in case of a limited disease which is only extending till attic and aditus good anatomical and hearing results could be gained.

Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate

Background Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. Aims/Objectives To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. Material and Methods We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. Results Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. Conclusions and Significance Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

The Emerging Surgical Concepts and Principles of Attic and Postero-Superior Wall Reconstruction by Auricular Cartilage and Free Fibro-Periosteal Tissue in Middle Ear Surgery. An Exposition on Surgical Experiences, Observations and Mistakes.

In middle ear surgeries, addressing the pathologies (cholesteatoma, retractions or tympanosclerosis) in attic or postero-superior area, are associated with difficulties like reconstruction of attic and postero-superior canal wall after clearing the disease. There are various graft materials available for such attic reconstruction in intact canal -wall surgeries. We describe our experience of attic and postero-superior canal wall reconstruction in combined approach tympanoplasty (CAT) using free auricular cartilage and free fibro-periosteal tissue and to present our results in anatomical and functional perspectives. This retrospective observational study was conducted in a tertiary care center which comprised 25 cases of combined approach tympanoplasty (with attic wall reconstruction) which were operated for attic cholesteatoma, tympanosclerosis or adhesive otitis media from January 2017 to December 2019 in our otolaryngology department. Outcomes were evaluated in audiological and morphological dimensions and paired "t" test (significant p value <0.05) was used to analyse the audiological data. A total of 25 cases (22 primary and 3 revision cases) were included in the study. Defect in attic and posterosuperior canal wall was caused by pathology (disease itself) in 2 cases, surgically created (intraoperatively to clear the disease) in 11 cases and both by pathology and surgically in 12 cases. 22 cases had successful graft uptake, with a morphological success rate of 88%, whereas graft failure was encountered in 3 cases. Complications observed were post-operative otorrhea (2 cases), recurrence (3 cases), no hearing improvement despite intact graft (1 case) and worsening of hearing post operatively in 1 case. Pre-operative ACT (Air conduction threshold) was 45.96 ± 12.47dB and the post-operative ACT was 38.61 ± 9.76dB (p value = 0.0246). Pre-operative ABG (Air-bone gap) was reduced from 30.58 ± 11.06dB to the post-operative ABG of 21.89 ± 6.24dB (p value = 0.0013). Reconstruction of postero-superior canal wall and attic defects in CAT using auricular cartilage and fibro-periosteal tissue (over mastoid cortex) is a novel method and associated with satisfactory morphological and audiological results. It is also effective in preventing postoperative retractions.

Tympanic Retraction Pockets: Diagnostic and Therapeutic Aspect

<i>Background</i>: Retraction pockets represent a form of chronic otitis considered to be a precholesteatomatous stage. This study aims to study the diagnostic and therapeutic aspects of tympanic retraction pockets in the ENT department of the University Hospital Center “Gabriel Touré”. <i>Patients and Method</i>: This was a prospective longitudinal study extended over 15 months; from February 1, 2020 to May 31, 2021 from the files of patients received as an outpatient in the ENT and Cervicofacial Surgery department of the CHU Gabriel Touré in Bamako. Were included any patient seen in an outpatient department at the otorhinolaryngology and head and neck surgery department of the CHU Gabriel Touré in Bamako with a pocket of tympanic retraction and who had consented to the study. Data collection was done using a previously established survey form. Data were entered in Word 2016 and analyzed using SPSS software. <i>Results</i>: The prevalence of retraction pockets was estimated at 1.2% of all consultations. The most represented age group was that of (25-39 years), i.e. 25.0%. The average age was 44.91 ± 20.05 years. The extremes of ages were 10 years and 81 years. The female sex was the most represented, at 63.9% with a sex ratio ꞊ 0.6. A history of otitis was present in half of the cases. Tinnitus was the main reason for consultation (50% of cases) followed by hearing loss (25%). The otoendoscopic examination had noted a predominance of lesions on the left (52%) and an attical seat in 30.6% of cases. The pockets were controllable and self-cleaning in all cases, and peelable in 75% of cases (stage I of the weevil classification) and non-peelable and controllable in 25% of the cases (stage II of weevil). Conductive hearing loss was found in 8.3% of cases, mixed hearing loss in 5.6% of cases and sensorineural hearing loss in 2.8% of cases. CT of the rock was performed in two patients, and showed erosion of the attic wall associated with tissue hypodensity in the attic. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stages I of charachon, i.e. 75% of the workforce. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon) ie (2, 88%). Antroatticotomy associated with reinforcement tympanoplasty was performed in a patient (0,36%).

Endoscopic stapes surgery: How I do it?

The use of endoscope in the field of ear surgery has done the revolutionary changes. The optical advantage of endoscope helps the otologist to perform the stapes surgery very conveniently. The main advantage of the endoscope in stapes surgery over the microscope is; the better preservation rates of the chorda tympani nerve (CTN), minimal curetting of the outer attic wall, hence minimizing the iatrogenic injury to the CTN. Apart from that, the audiometric results following the endoscopic stapes surgery is comparable with the microscopic surgery. We had performed the stapes surgery with the rigid nasal endoscopes (Karl Storz) of 4-mm diameter and 18-cm length. Our preliminary results showed that transcanal endoscopic stapedotomy is a reliable and safe technique for the surgical management of otosclerosis.

Novel Method of Cartilage Harvest in Otology with Micro Dermatome: A Descriptive Study.

Cartilage is used in middle ear surgery for reconstruction of tympanic membrane, ossicular chain, posterior canal wall and lateral attic wall. When used in tympanic membrane reconstruction, thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. We have used a microdermatome for precise reduction of the thickness of the cartilage. This also allows us to select exact thickness of cartilage slice and also permits slicing from donor site directly. To describe the use of novel method of cartilage slicing using a micro dermatome and to report our preliminary experience. This is a descriptive study, with a total number of 350 cartilage grafts used in tympanoplasty and mastoidectomies have been prepared with micro dermatome from 2019 to 2021. Our study reports the technique of slicing the Conchal cartilage and how its uniform measurement can be obtained. Our modified technique using the micro dermatome is easy to master, provides precise cartilage thickness as per needs within a short span of time. Harvesting from the donor site is as per the graft requirement and rest of the cartilage is left in place for the future revision surgery if needed. The cartilage obtained were structurally integral without any undue breakage and functionally stable. The thickness of the cartilages obtained makes it pliable for easy handling and placement in ear surgeries.

Clinical analysis of 21 cases of cholesteatoma recidivism after canal-wall-up mastoidectomy with tympanoplasty

Objective:To discuss the possible reasons for cholesteatoma recidivism after canal-wall-up mastoidectomy with tympanoplasty by analyzing clinical characteristics of patients. Methods:Data of 21 cases who suffered from cholesteatoma recidivism after canal-wall-up surgery were retrospectively reviewed, including preoperative examination, high resolution temporal bone CT, and intraoperative findings. Results:90.5%（19/21） cases had recurrent cholesteatoma with retraction pockets. Among 12 cases with previous operative notes, 66.7%（8/12） had extensive cholesteatoma which was not limited to attic in the original surgery. The intraoperative features of revision surgery in 21 patients including the destruction of reconstructive lateral attic wall and scutumwere found in 19.0%（4/21） cases, the head of malleus left in 19.0%（4/21） cases, the cholesteatoma found in hidden part in 14.3%（3/21） cases, the hadeustachian tube dysfunction in 38.1%（8/21）cases. the sclerotic mastoid in 42.9%（9/21） cases. hadanatomic variations of the temporal bone in 14.3%（3/21） cases and atresia of external auditory canal in 4.8%（1/21） cases. Conclusion:In this group of recidivism cases, most patients had extensive cholesteatoma, which may lead to excessive mucosa loss during lesion clearance, poor ventilation of tympanic isthmus after surgery, and promote the formation of retraction pocket. In addition, some cases had eustachian tube dysfunction, unstable reconstruction of attic lateral wall, and improper selection of the indications, which may also increase the risk of recurrence. Therefore, in order to reduce cholesteatoma recidivism after canal-wall-up surgery, attention should be paid to the striction of surgical indications, comprehensive preoperative evaluation, thorough clearance of lesions and firm reconstruction.

Reconstruction of the outer attic wall by cortical bone and bone cement.

To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. There was significant improvement of persistent otorrhea and hearing loss after surgery (P<0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.

AUTHOR'S METHOD OF CONTINUUM STATES ON THE EXAMPLE OF IMPERFECTION IN THE CONSTRUCTION OF A LARGE-PANEL BUILDING

The paper presents the results of FEM computer analysis regarding cracking of the wall prefabricated element. The proprietary coating model of the Wk-70 System large-panel building construction was used. For analysis, a construction diaphragm has been separated that is integrally connected to the vertical communication structure. Modeled through the scratch in the attic wall and compared with the wall model without damage. By building the shell model, a real and transparent picture of the static work of the structure was obtained, distinguishing zones: focus, redistribution, compensation and neutralization of stresses, whose genesis results from imperfection - scratches in a reinforced concrete composite. For the first time, the author introduces his own method of assessing the safety status of large-panel buildings - by the States Continuum Method.

A rare case of epidermal inclusion cyst: an unusual complication of ear surgery

BackgroundEpidermal inclusion cysts are common tumours of the hand in industrial workers caused by entrapment of epidermal elements within the dermis. They are unusual in the head and neck region more so in the temporal region.Case presentationWe present a 27-year-old man with a 3-month history of a slow-growing swelling in the left temporal region. He had a history of chronic otitis media and underwent an end-aural tympanomastoid surgery 5 years earlier. Physical examination revealed a 5 × 3 × 2.5 cm cystic globular minimally tender mass in the temporal fossa along with squamous active otitis media with bony erosion of the outer attic wall. High-resolution computed tomography of the left temporal bone revealed otomastoiditis with erosion of the scutum; ossicles were not identified. We hereby describe the diagnostic challenge and the plan of management of this lesion.ConclusionsEpidermal inclusion cyst must be considered in the differential diagnosis of temporal fossa lesions especially in patients with a prior history of ipsilateral tympanomastoid surgery.

CANAL WALL RECONSTRUCTION SURGERY IN RETRACTION PATHOLOGYEXPERIENCE AT AL NAHDHA HOSPITAL*, OMAN

Abstract Objectives: Tympanic membrane retraction pathology is a frequently encountered middle ear problem that can be a self cleansing pocket, a deep sac with hidden cholesteatoma or a potential reservoir for its future formation. In selected cases, a defect in attic and posterior superior canal wall can result after surgical removal of the diseased epithelium and/or cholesteatoma. If this occurs, reconstruction is usually attempted. Avoiding an open cavity in such conditions is currently the preferred approach. We sought to study the cartilage reconstruction outcomes of the attic and/or posterior superior canal wall defects for selected cases of retraction pathology without a need for an open mastoid cavity. We investigated the short and long term results with regards to the resorption with time, displacement or recurrence of cholesteatoma. Methods: This is a retrospective study conducted at Al Nahda Hospital in Oman between 2008 and 2014. A total 301 patients who underwent inside-out atticotomy with attic defect repair or cortical mastoidectomy with atticotomy and attic defect repair were included in the study. Staging and classication criteria for middle ear cholesteatoma proposed by the Japan Otological Society (JOS) were applied based on surgical and follow-up notes in cases with recurrent cholesteatoma. The status of the reconstructed part of the outer attic wall with respect to survival and stability of cartilage was assessed carefully at less than six months (short term) and at more than two year periods (long term) after surgery. Results: Out of 301 patients who underwent mastoid surgeries between 2008 and 2014, 72 patients met the inclusion criteria. Results of both surgical methods were then assessed. It was noted that the longer the duration after postoperative period (&gt; 2 years), the more chance to have a recurrence of disease, displacement/ resorption of the reconstructed part or retraction/perforation of tympanic membrane (p &lt; 0.026). Moreover, the reconstruction part of the attic and posterior superior canal wall may be resorbed with time in some cases as shown in this study (9.4%). However, the rate is low and worth considering in all the cases of attic or selected atticoantral cholesteatomas. Conclusion: Resorption and displacement of the reconstructed part of the attic and/or posterior superior canal wall was observed during the follow–up period of this study. This may have contributed to the retraction pocket reformation followed by the recurrence of cholesteatoma. It was noted to be more obvious during long duration of follow-up. Hence, we recommend a longer follow-up of at least 2 years post operatively even if the ndings are showing good results during initial visits. Although the recurrence rate of disease with the used surgical methods in this study was 16.9%, in order to compare the results of this surgical method with either canal wall up or canal wall down, future surgical methods will require a randomized trial. Key words: Cholesteatoma, mastoidectomy, reconstruction, cartilage, canal wall, atticotomy

Mrmc Neo Surgical Ventilating Port and Neo Attic Malleo-Incudal Complex in Endoscopic Management of Limited Attico-Antral Cholesteatoma.

To study functional outcome of the endoscopic management of limited attico-antral cholesteatoma in terms of visualization of sac, cholesteatoma disease clearance, ABG closure improvement, preservation of residual anatomy and recurrence of disease. It is a prospective study done during Feb 2016 to March 2017 done on 20 pts with limited attico-antral cholesteatoma with CT confirmation. Endoscopic management of limited attico-antral cholesteatoma with complete removal of sac, infected discharge and granulations along with creation of MRMC Neo surgical ventilating port (joining Anterior & posterior isthmuses) done in cases where residual attic anatomy was present to establish physiological attic ventilation and drainage. Whereas in cases of attic and ossicular erosion, ossiculoplasty along with neo attic malleo-incudal complex (with composite tragal cartilage with perichondrium graft) for lateral attic wall reconstruction was done to prevent attic retraction. Patients had mean pre op ABG of 36.29±6.29 and mean post op ABG closure of 16.33±6.50 with no recurrence of cholesteatoma at 6months of follow up. Patient showed significant (55%) improvement in hearing with all having graft uptake in which four cases having mild pars tensa retraction which recovered later without any intervention. Thus creation of new MRMC Neo surgical ventilating port or neo attic malleo-incudal complex with endoscopic approach allows better visual access to clear the limited attico-antral disease with sparing of normal residual attic anatomy along with physiological ventilation and drainage having better hearing results and outcome.

Reconstruction of lateral attic wall in acquired cholesteatoma

Background/Aim. Attic cholesteatoma is an epithelial cystic pseudotumor which arises in the top compartment of the middle ear. Surgery is the only therapeutic treatment for attic cholesteatoma. The aim of this study was to analyze the surgical and audiological results in tympanoplasties that use a logical application of several techniques for the management of attic cholesteatoma. Our hypothesis was that the tympanoplasty technique with cartilage/bone reconstruction of the achieve better outcome than the tympanoplasty technique with only temporal fascia reconstruction of the lateral attic wall. Methods. This retrospective clinical study included 80 patients, aged 16?65 years, with attic cholesteatoma undergoing canal ?wall up? tympanoplasty with lateral attic wall reconstruction, under general anesthesia in the Eear, Nose and Throat Clinic, Military Medical Academy in Belgrade between 2006 and 2010. The patients were divided into two groups according to the type of lateral attic wall reconstruction: the group I of 60 patients with cartilage/bone plus temporalis fascia lateral attic wall reconstruction and the group II of 20 patients with only temporal fascia lateral attic wall reconstruction. Postoperative follow-up examinations were done at least 5 years after the surgery. The ?2 test was used to compare postoperative sequelae for two groups of operated patients with lateral attic wall reconstruction. The independent and paired samples t-test of air conduction and air-bone gap were used to compare the results of preoperative and postoperative hearing tests. Results. The differences between hearing measurements of the two groups according to preoperative and postoperative auditory thresholds of the air conduction and the air-bone gap were considered no statistically significant. The difference between the two groups recarding to recurrent attic retraction pocket appearance and recurrence of cholesteatoma was considered statistically significant and the results were much better in the group I of the operated patients with cartilage/ bone lateral attic wall reconstruction. Conclusion. ?Wall up? tympanoplasty for attic cholesteatoma with lateral attic wall reconstruction leads to good anatomical and audiological results. A significant hearing improvement was obtained in both the types of lateral attic wall reconstructions in this study. Reconstruction with cartilage or mastoid cortex bone showed favorably long-term functional and anatomical results compared to primary tympanoplasty using only temporal fascia for lateral attic wall reconstruction in cases of attic cholesteatoma.

Lateral Attic Wall Reconstruction with Glass Ionomer Bone Cement in the Management of Primary Acquired Attic Cholesteatoma in Children: A Preliminary Experience.

To assess the effectiveness of glass ionomer bone cement (GIBC) in lateral attic wall reconstruction after primary acquired attic cholesteatoma surgery. This prospective study was conducted on twenty children collected from the ENT outpatient clinics of a secondary and tertiary hospital. All patients presented with chronic suppurative otitis media with cholesteatoma of the primary acquired attic type. All patients underwent intact canal wall mastoidectomy (ICWM) with a transcanal atticotomy to address primary cholesteatoma involving the attic and the supratubal recess. Removal of the incus with or without decapitation of the malleus depended on the extension of the pathology. GIBC was used to build up the lateral attic wall in all cases. Ossiculoplasty and tympanoplasty were performed according to the extent of disease. All patients had integrated skin covering the reconstructed attic wall with no signs of granulation tissue formation, canal wall edema, glass ionomer extrusion, or foreign body reaction on the 6th month, 1st year and 2nd year follow-up visits. Also, no persistent otorrhea was noted. The postoperative air-bone gap was significantly improved (p=0.007). GIBC could be considered as a reliable artificial material for reconstruction of the lateral attic wall after transmeatal atticotomy in ICWM, making it feasible to avoid cavity problems of canal wall down mastoidectomy, especially in children.

Life table analysis of results of staged intact canal cholesteatoma surgery using bone pate to reconstruct the lateral attic wall

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

INTRODUCTION: The aim of the study was to compare hearing results between tympanoplasty with attic wall reconstruction and attic obliteration. MATERIAL AND METHODS: A prospective study included 88 patients who were operated for chronic suppurative otitis media (CSOM) and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Analysis of variance (ANOVA) was conducted to assess the impact of two different techniques of tympanoplasty: attic wall reconstruction and attic wall obliteration on patients` hearing. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Cholesteatoma was found in 54 (61.4%) patients: 31 (35.2%) sinus cholesteatoma, 20 (22.7%) attic cholesteatoma, 3 (3.4%) tensa tympanic cholesteatoma, and 34 cases (38.6%) of CSOM. Lateral attic wall and ossicular chain reconstruction was performed in 33 cases with subsequent attic reconstruction if the long process of the incus and the incudo-stapedial joint were missing. A mixed between-within-subjects analysis of variance showed significant improvement of PTA postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.33, F(1,86)=172.1, p<0.001. ANOVA showed significant improvement of ABG postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.23, F(1,86)=286.3, p<0.001. Hearing improvement was measured in both cases, the ABG closure and mean PTA improvement was larger in the attic reconstruction compared to attic obliteration technique. CONCLUSION: Attic wall reconstruction with cartilage provides better postoperative hearing compared to attic obliteration. Attic reconstruction in revision cases for cholesteatoma recurrence is not recommended.

Magnetically driven middle ear ossicles with laser vibrometry as a new diagnostic tool to quantify ossicular fixation

Conclusion: Information on the degree of incus fixation can be gathered by measuring the ratio of incus to umbo long process velocity through the ear canal. Objectives: To test a new method of quantifying partial ossicular fixation in an ear with an elevated tympanic membrane. Methods: Measurements were made on four fresh-frozen human temporal bones. After elevating the tympanic membrane a small magnet was attached to the manubrium and an electromagnetic excitation coil was used to vibrate the ossicles. The vibration response of the tip of the incus long process and the umbo were measured before and after artificially fixating the incus to the lateral attic wall. Results: Partial incus fixation resulted in a decrease in both the incus and umbo velocities, with the incus velocity being more severely reduced. The decreased ratio of their vibrations is a clear indicator of the degree of incus fixation.

Imaging Findings in Auto-Atticotomy

An acquired attic cholesteatoma may spontaneously drain externally into the external auditory canal, leaving a cavity in the attic with the shape of the original cholesteatoma but now filled with air, a phenomenon referred to as "nature's atticotomy" or auto-atticotomy. We describe and quantify the CT appearance of the auto-atticotomy cavity as it pertains to the appearance of the scutum and the lateral attic wall. Twenty-one patients with erosion of the scutum and loss of the lower attic wall on MDCT were identified during a 5-year span. Images were assessed for measureable widening of the space between the ossicles and the lower lateral attic wall in the axial and coronal planes. Three measurements of the lateral attic were made on the axial images. Findings were compared with the same measurements in 20 control subjects. The 21 patients had a characteristic blunting of the scutum with loss of the lower lateral attic wall and widening of the lateral attic, consistent with an auto-atticotomy. There was a statistically significant (P < .001) widening of the lateral attic dimensions in the axial plane in the patients with auto-atticotomy. Spontaneously evacuated cholesteatoma may mimic a surgical atticotomy on MDCT. Scutal erosion and attic enlargement with a smoothly contoured bony remodeling of the lower lateral attic wall in a patient with no history of surgery suggest that a cholesteatoma was previously present and spontaneously drained.

Evaluation of Temporal Bone Cholesteatoma and the Correlation between High Resolution Computed Tomography and Surgical Finding

BackgroundAcquired cholesteatomas are commonly seen in patients less than 30 years. There is a typical history of recurrent middle ear infections with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination.ObjectiveThe aim of the work was to study the role of high resolution computed tomography (HRCT) in detecting, evaluating, and diagnosing middle ear cholesteatoma.Patients and methodsThis was a prospective study that included 56 consecutive patients with chronic suppurative otitis media, unsafe type cholesteatomas. Each patient was subjected to full clinical evaluation, and HRCT examination. Intravenous contrast media was used in some patients with suspected intracranial complication. Preoperative radiological data were correlated with data related to surgical findings.ResultsThe study showed that a high incidence of cholesteatoma in the third decade of life. The scutum and lateral attic wall were the most common bony erosions in the middle ear bony wall (64.3%), and the incus was the most eroded ossicle in the middle ear (88.2%). Sclerosing of mastoid air cells were encountered in 60.7% of patients and the lateral semicircular canal was affected in 9%, while facial canal erosion was found in 21.4%. Temporal bone complications are more common than intracranial complications.HRCT findings were compared with operative features; the comparative study included the accuracy and sensitivity of HRCT in detecting cholesteatoma (92.8%), its location and extension (96.4%), ossicular chain erosion (98%), labyrinthine fistula and intracranial complications (100%).ConclusionThe important role of HRCT scannig lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.

Attic Reconstruction in Pediatric Canal Wall‐up Mastoidectomy

Objective: 1) To evaluate 3 methods: conchal cartilage, tragal cartilage, and bone pate, for primary attic reconstruction (scutumplasty) in pediatric canal wall-up mastoidectomies in terms of recurrence rates and formation of retraction pockets. Method: All patients undergoing attic reconstruction following a canal wall up mastoidectomy were evaluated from a single surgeon prospective pediatric otological database maintained over a 10-year period. The reconstruction of the scutum defects was done using bone pate, conchal and tragal cartilage. The outcome measures were postoperative retraction pocket formation and recurrence of cholesteatoma. Results: A total of 120 patients underwent primary attic reconstruction following canal wall-up mastoidectomy over a 10-year period. The overall recurrence rate was 9.83% (n = 12). Fifty-one patients underwent attic reconstruction with tragal cartilage, while 33 were reconstructed using conchal cartilage and 36 with bone pate. The recurrence rate with various reconstruction methods was 5.8% (n = 2), 15.1% (n = 5), and 13.8% (n = 5) for tragal, conchal, and bone pate, respectively. Cholesteatoma recurrence rates with the use of tragal cartilage for reconstruction of the scutum were significantly lower as compared to that of conchal cartilage ( P = .034, chi square = 3.308) and bone pate ( P = .046, chi square = 2.834). Conclusion: The use of the tragal cartilage for scutum reconstruction is associated with the least recurrence rate for pediatric cholesteatoma. The easy accessibility, stability, and good long-term results with the use of the tragal cartilage makes it an ideal material for outer attic wall reconstruction in pediatric canal wall up mastoidectomies.