Classification and surgical management of localized attic cholesteatoma: single-institution experience and follow-up.
OBJECTIVE
To present an effective system for the evaluation and surgical management of localized attic cholesteatoma, as well as describing the follow-up of patients treated at our institution.


METHODS
Retrospective review of single-institution experience.


METHODS
A total of 71 patients (71 ears) with localized attic cholesteatoma received atticotomies. Further surgical management was then carried out according to the extent of the cholesteatoma and whether the malleoincudal joint was preserved (type I) or not (type II). There were 27 type I patients and 44 type II patients. In all 71 patients, the lateral wall of epitympanum was rebuilt with tragal cartilage. The healing of the lateral wall of the attic and the tympanic membrane as well as the recovery of hearing level were assessed after the operation.


RESULTS
The follow-up periods lasted 3-6 years, with an average of 4.5 years. The healing of the lateral wall of the epitympanum was satisfactory in all 71 patients. According to pure tone audiometry conducted after the operation, the air-bone gap was <10 dB in 43 patients, <20 dB in 23 patients, <30 dB in 4 patients, and >30 dB in only 1 patient. No vertigo or tinnitus was experienced after the operation.


CONCLUSIONS
The surgical management of localized attic cholesteatoma should be planed according to the extent of the cholesteatoma and especially the condition of the malleoincudal joint. In order to prevent a subsequent retraction pocket of the attic, it is important to rebuild the lateral wall of the attic with cartilage after clearing the cholesteatoma.
Zhang
Zhi Gang
ZG
Department of Otolaryngology, 2nd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.
Chen
Sui Jun
SJ
Sun
Wei
W
Zheng
Yi Qing
YQ
D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D002356:Cartilage / Q000601:surgery; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007188:Incus / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008307:Malleus / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D055815:Young Adult