Objective: To investigate the clinical classification and treatment of localized attic cholesteatoma through surgical management.
Method: Twenty-one patients (21 ears) of localized attic cholesteatoma accepted atticotomy. Then different surgical managements were carried out according to the extent of cholesteatoma and whether the malleo-incudal joint was destroyed or not. If the cholesteatoma has only reached the surface of the malleo-incudal joint, it was regarded as type I (5 patients). To this type, the cholesteatoma was removed and the ossicular chain was preserved. If the cholesteatoma has entered the anterior attic space and destroyed the malleo-incudal joint, it was regarded as type II (16 patients). Besides the removing of cholesteatoma, the head of malleus and incus should be removed also in this condition. Then reconstruction of the ossicular chain was performed by putting PORP artificial auditory ossicles between the manubrium mallei and staple. In all these 21 patients, the lateral wall of attic was reconstructed with the cartilage of tragus. The perichondrium of the cartilage was used to repair the perforation in the non-vibrant membrane. Healing of the lateral wall of attic and the tympanic membrane and recovery of hearing level were investigated after the operation.
Result: The follow-up period lasted 1 year to 5 years. Healing of the lateral wall of attic and the tympanic membrane were satisfying in all 21 patients. According to the pure tone audiometry after the operation, A-B gap was less than 10 decibel in 10 patients,less than 20 decibel in 7 patients, less than 30 decibel in 3 patients, and over 30 decibel in only 1 patient. Acoustic transmission function was preserved or reconstructed. No vertigo or tinnitus happened after operation.
Conclusion: Diagnosis of localized attic cholesteatoma should be made early. If it can be treated by clinical classification properly, not only the removing of cholesteatoma, but also the reservation and recovery of acoustic transmission function can be obtained. It is worthy of further discussion.