Long-Term Outcome of Atticotomy for Cholesteatoma in Children

DeRowe, Ari; Stein, Gidon; Fishman, Gadi; Berco, E; Avraham, Shabtai; Landsberg, Roee; Sadé, Jacob

doi:10.1097/01.mao.0000169789.45577.8a

Cited by 15 publications

(15 citation statements)

References 7 publications

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“…Moreover, although the concept of functional microsurgery (i.e. retrograde atticotomy-limited mastoidectomy) for cholesteatoma has been used widely [Dornhoffer, 2000;Lan et al, 2003;DeRowe et al, 2005;Uyar et al, 2006;Nikolopoulos and Gerbesiotis, 2009;Roth and Haeusler, 2009;Hatano et al, 2010], otologists may have made slightly different modifications to this technique. Consequently, our results may not be easily extrapolated to other population groups that have been operated on using different modified methods.…”

Section: Discussionmentioning

confidence: 99%

“…In pediatric cholesteatoma surgery, many surgeons are less likely to utilize 'radical' wall-down approaches due to the prospect of life-long mastoid cavity maintenance [Preciado, 2012]. Hence, the concept of surgeries that preserve function has aroused the interest of some otologists for clinical application for cholesteatoma [Dornhoffer, 2000;Lan et al, 2003;DeRowe et al, 2005;Uyar et al, 2006;Nikolopoulos and Gerbesiotis, 2009;Roth and Haeusler, 2009;Hatano et al, 2010]. The goal of this method is to create less structural damage and to maintain greater preservation of the uninvolved functional middle ear cleft.…”

Section: Discussionmentioning

confidence: 99%

“…However, a technically feasible and safe alternative to conventional canal wall up or down technique, atticotomy-limited mastoidectomy with cartilage reconstruction (inside-out ap- [Sadé and Halevy, 1976] and Tos [Tos and Poulsen, 1980] classifications. In cases of eardrum perforation, destruction of <50% of the middle ear mucosa is scored as 2 and >50% is scored as 3. proach), has been widely used by many surgeons in the treatment of cholesteatoma [Dornhoffer, 2000;Lan et al, 2003;DeRowe et al, 2005;Uyar et al, 2006;Nikolopoulos and Gerbesiotis, 2009;Roth and Haeusler, 2009;Hatano et al, 2010]. This method is a less invasive option that produces satisfactory long-term outcomes [Nikolopoulos and Gerbesiotis, 2009].…”

Section: Surgical Techniquesmentioning

confidence: 99%

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Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction

Kuo¹,

Shiao²,

Liao³

et al. 2012

Audiol Neurotol

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Objective: Following cholesteatoma surgery, effective long-term hearing preservation in children is difficult and is not typically expected. Hence, long-term data on hearing outcomes are lacking. The aim of this study was to analyze long-term hearing outcomes in children following cholesteatoma surgery. Methods: For this study, 49 ears in 47 children (≤16 years) with acquired cholesteatomas following atticotomy-limited mastoidectomy with cartilage reconstruction (inside-out approach) during 1986–2010 were included. Pre- and post-operative recidivism-free audiometric results were compared. Hearing success was defined as a post-operative air conduction (AC) threshold of ≤30 dB (serviceable hearing). Logistic regression analyses were used to evaluate potential prognostic factors that independently contributed to the prediction of hearing success. These factors included stapes condition, pre-operative AC threshold, ossicular chain integrity, disease severity, age, and gender. Results: The mean duration of follow-up was 14.2 years. The post-operative AC (33.55 ± 15.42 dB) and air-bone gap (17.88 ± 12.94 dB) were significantly improved compared with the pre-operative AC (42.90 ± 16.47 dB, p < 0.001) and air-bone gap (30.23 ± 13.68 dB, p < 0.001). The probability of hearing success following surgery (40.8%) was significantly higher than prior to surgery (24.5%, p = 0.008). Multivariate logistic regression analyses revealed a statistically significant correlation between hearing success and stapes integrity only (p = 0.005). Conclusions: This study provides important information on effective long-term hearing preservation over a mean follow-up of 14 years. In addition, stapes destruction is an independent negative prognostic determinant of achieving hearing success. The prediction model in this study provides otologists with useful pre-operative information to inform patients and parents on expected hearing outcomes and may be useful for post-operative observations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction

Kuo¹,

Shiao²,

Liao³

et al. 2012

Audiol Neurotol

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“…An atticotomy, atticoantrostomy or limited mastoidectomy are surgical steps appropriate for different sizes and locations of cholesteatoma. It is a less invasive option with satisfactory long-term outcomes [34,35]. The main advantages of this procedure include a much better view of the anterior mesotympanum, a better view of the attic and the creation of small cavities in the majority of cases.…”

Section: Resultsmentioning

confidence: 98%

“…In children, a single operation without the need of second look, a small mastoid cavity with minimal problems, and satisfactory hearing results seem to be important factors in order to choose the proposed third way to mastoid surgery that is a less invasive option with satisfactory long-term outcomes [34,35].…”

Section: The Third Way: Inside -Atticotomy/limited Mastoidectomymentioning

confidence: 99%

Surgical management of cholesteatoma: The two main options and the third way – atticotomy/limited mastoidectomy

Nikolopoulos¹,

Gerbesiotis²

2009

International Journal of Pediatric Otorhinolaryngology

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Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults

Bernardeschi

Russo

Nguyen

et al. 2016

Eur Arch Otorhinolaryngol

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Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow-up of 24 ± 12.2 months, and the results of a CT-scan performed 1 year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4 %) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19 ± 12.2 and 10 ± 7.3 dB pre-operatively and post-operatively, respectively (mean ± SD, p = 0.001, paired t test). Twenty-two patients (81 %) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15 %) presenting an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4 %) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1 year, and with closure of the air-bone gap by 50 %.

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Long-Term Outcome of Atticotomy for Cholesteatoma in Children

Abstract: In selected cases, AT can be a less invasive option in children with cholesteatoma limited to the attic and middle ear.

Cited by 15 publications

References 7 publications

Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction

Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction

Surgical management of cholesteatoma: The two main options and the third way – atticotomy/limited mastoidectomy

Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults

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