THE EFFECTIVENESS OF TYMPANIC ATTIC OBLITERATION TO PREVENT A POST-OPERATIVE RETRACTION POCKET

H. Shimogori, K. Sugahara, H. Yamashita

Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan

Introduction

The basic surgical procedure at our department is canal-wall-down tympanoplasty with canal reconstruction using hard tissue such as auricular cartilage. In the observation of post-operative developments, there has been a growing number of cases in which obliteration with hard tissue of the tympanic attic is executed simultaneously. In order to study the effectiveness of this surgical procedure, a study was conducted on the post-operative retraction pocket in cases of chronic otitis media with cholesteatoma that have been examined and treated on an outpatient basis during the six-months period ending on April 25, 2011.

Subjects and results

The subjects were 112 cases of cholesteatoma outpatients of our department during the six-months period from October 25, 2010, to April 25, 2011. Of these, 38 underwent tympanic attic obliteration and 74 did not undergo the surgical procedure. Of the cases of tympanic attic obliteration procedure, eight (21.1%) developed a retraction pocket, and 30 (78.9%) did not. Of those who did not undergo tympanic attic obliteration, 30 (40.5%) developed a retraction pocket, while 44 (59.5%) did not. Of the total of 112, 38 (33.9%) developed a retraction pocket. The analysis of the 38 cases of retraction pocket by area of retraction revealed that the postero-superior quadrant (PSQ) was the area for the largest number (three or 37.5%) in the obliteration group, and the tympanic attic was the area for the largest number (15 or 50.0%) in the non-obliteration group. Of the total of 112, the number of cases of re-operation due to post-operative recurrence was 27. In these cases, the retraction pocket was examined post-operatively whether obliteration was done or not. In the obliteration group, a retraction pocket was found in three out of 14 (21.4%). In the non-obliteration group, the ratio was eight out of 13 (61.5%)

Discussion and conclusion

Tympanic attic obliteration was found to reduce a post-operative retraction pocket in the attic naturally. However, the retraction pocket increased for PSQ. It is believed that it is necessary to reinforce the PSQ area with thinly-sliced cartilage in the future. For the re-operation cases due to recurrence, it was found that obliteration of the tympanic attic clearly reduces a post-operative retraction pocket.

Address for correspondence: Hiroaki Shimogori, Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, 1–1-1 Minamikogushi, Ube city, 755–8505, Japan. shimo-h@yamaguchi-u.ac.jp

Cholesteatoma and Ear Surgery – An Update, p. 449

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands