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Atticosinoplasty for early cholesteatoma management

Presenting Author: Yun-Hoon Choung

Published online by Cambridge University Press:  03 June 2016

Yun-Hoon Choung
Ajou University School of Medicine
Oak-Sung Choo
Ajou University School of Medicine
Sang Young Hong
Ajou University School of Medicine
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Copyright © JLO (1984) Limited 2016 

Learning Objectives:

Objective: These days surgery rates for early cholesteatoma and residual or recurrent cholesteatoma are increasing. For this matter, Prof. Keehyun Park suggested a surgical technique called ‘atticosinoplasty’ to mediate early cholesteatoma. Thus, we analyzed the adequacy and applicability of atticosinoplasty as a treatment for early cholesteatoma comparing with other surgical techniques.

Materials & Methods: One hundred seventy two patients who underwent atticosinoplasty (n = 72) or canal wall up mastoidectomy (n = 73) in Ajou University Hospital (Suwon, Korea) between 2002 and 2014 were enrolled in this study. Patients with less than 12 months of follow up period were excluded from this study. During the follow up, post-operative physical examination and audiometry were performed including temporal bone CT in necessary cases. Based on these data, recurrence and re-operation rate, pre- and post-operative hearing levels, and hearing gain were compared between both groups.

Results: The atticosinoplasty technique includes the removal of cholesteatoma through atticotomy or posterior sinusectomy, removal of incus and malleus, transmeatal endoscopic exploration, ossicle reconstruction and wall reconstruction with cartilage. There was no significant difference of hearing gain (PTA) between the atticosinoplasty group (44/72 patients) and the CWUM group (47/73 patients). Decrease of air-bone gap was detected in 61% (44/72) patients in the atticosinoplasty group and in 64% (47/73) in the CWUM group (p > 0.05). Revision mastoidectomy was performed in 3 (4.2%) in the atticosinoplasty group and in 4 (5.4%) in the CWUM group. However, revision ossiculoplasty was done less in the atticosinoplasty group (7, 9.7%) rather than the CWUM group (18, 24.6%) (p < 0.05).

Conclusion: Atticosinoplasty can be considered as an effective surgical technique for the treatment of early cholesteatoma, resulting in low recurrence rate and improved hearing.