A Study on the Clinical Outcomes of Scutumplasty in Cases of Attic Cholesteatoma

Abstract

A B S T R A C T BACKGROUNDAttic cholesteatoma surgeries with varying techniques give variable results, with no defined gold standard procedure. So, the above needs to be studied extensively. Chronic Suppurative Otitis Media (CSOM) is a common condition seen in patients attending the Otolaryngology clinic. It is a chronic/long standing inflammation of the middle ear cleft which is composed of eustachian tube, hypotympanum, mesotympanum, epitympanum, aditus and mastoid air cells. Clinical features include recurrent otorrhoea through a tympanic perforation, conductive hearing loss and bleeding. We aimed to investigate the clinical results of scutumplasty in patients with an attic cholesteatoma and assess the pre & post-operative air bone gap. METHODSThis is a prospective interventional study. 50 patients with attic cholesteatoma were operated upon, using scutumplasty. Preoperative patient's otology database was compared with regards to operative findings and methods, postoperative physical examination and postoperative audiometry. RESULTSThe mean preoperative and postoperative air-bone gaps were 36.8±14.8 dB and 27.1±11 dB, respectively (p=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5±9.7 dB and 15.23±14.0 dB, respectively (p=0.411). Postoperative retraction occurred in 16% of patients and recurrent cholesteatoma was detected in 3 cases (6%) for which revision surgery was performed. CONCLUSIONSScutumplasty showed a low disease recurrence rate and no deterioration in hearing levels. With intact malleus head or body of incus, attic reconstruction was possible and this procedure lead to improved hearing. However, a problem that still needs to be addressed in future is postoperative retraction.