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 (> 2 years), the more chance to
have a recurrence of disease, displacement/
resorption of the reconstructed part or
retraction/perforation of tympanic membrane (p
< 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
CANAL WALL RECONSTRUCTION SURGERY IN
RETRACTION PATHOLOGYEXPERIENCE AT AL NAHDHA HOSPITAL*, OMAN
