Abstract
To study functional outcome of the endoscopic management of limited attico-antral cholesteatoma in terms of visualization of sac, cholesteatoma disease clearance, ABG closure improvement, preservation of residual anatomy and recurrence of disease. It is a prospective study done during Feb 2016 to March 2017 done on 20 pts with limited attico-antral cholesteatoma with CT confirmation. Endoscopic management of limited attico-antral cholesteatoma with complete removal of sac, infected discharge and granulations along with creation of MRMC Neo surgical ventilating port (joining Anterior & posterior isthmuses) done in cases where residual attic anatomy was present to establish physiological attic ventilation and drainage. Whereas in cases of attic and ossicular erosion, ossiculoplasty along with neo attic malleo-incudal complex (with composite tragal cartilage with perichondrium graft) for lateral attic wall reconstruction was done to prevent attic retraction. Patients had mean pre op ABG of 36.29 ± 6.29 and mean post op ABG closure of 16.33 ± 6.50 with no recurrence of cholesteatoma at 6 months of follow up. Patient showed significant (55%) improvement in hearing with all having graft uptake in which four cases having mild pars tensa retraction which recovered later without any intervention. Thus creation of new MRMC Neo surgical ventilating port or neo attic malleo-incudal complex with endoscopic approach allows better visual access to clear the limited attico-antral disease with sparing of normal residual attic anatomy along with physiological ventilation and drainage having better hearing results and outcome.
Similar content being viewed by others
References
Thomassin JM, Duchon-Doris JM, Emram B et al (1990) Endoscopic ear surgery. Initial evaluation. Ann Otolaryngol Chir Cervicofac 107:564–570
Marchioni D, Alicandri-Ciufelli M, Molteni G et al (2011) Ossicular chain preservationafter exclusive endoscopic transcanaltympanoplasty: preliminary experience. Otol Neurotol 32(4):626–631. doi:10.1097/MAO.0b013e3182171007
Proctor B (1989) Cavities of the temporal bone. Surgical anatomy of ear and temporal bone. Thieme Medical Publishers, New York, pp 39–128. ISBN 0865772959
Mansour S, Magnan J, Haider H, Nicolas K, Louryan S (2013) Middle ear compartments. Comprehensive and clinical anatomy of middle ear. Springers, Heidelberg, pp 83–102. doi:10.1007/978-3-642-36967-4
Glasscock ME (1990) Pathology and clinical course of inflammatory diseases of middle ear. In: Micheal E, Glasscock III, Shambaugh GE (eds) Surgery of the ear, 4th edn. W.B. Saunders Company, Philadelphia, pp 167–193
Palva T, Johnsson L-G, Ramsey H (2000) Attic aeration in temporal bones from children with recurring otitis media. Tympanostomy tubes did not cure disease in Prussak’s space. Am J Otol 21(4):485–493 (PMID:10912692)
Stamberger H, Hawke M (1993) Basic principles of functional endoscopic sinus surgery. Essentials of functional endoscopic sinus surgery. Mosby Elsevier, London, pp 3–12
Francis HW (2010) Anatomy of the temporal bone, external ear, and middle ear. In: Flint WP et al (eds) Cummings otolaryngology head and neck surgery, vol 3, 5th edn. Mosby Inc, Philadelphia, pp 1833–1842
Proctor B (1991) Chronic otitis media and mastoiditis. In: Paparella MM, Shumrick DA (eds) Otolaryngology (otology and neuro-otology), vol 2, 3rd edn. W.B. Saunders Company, Philadelphia, pp 1349–1376
Sheehy JL, Brackman DE, Graham MD (1977) Cholesteatoma surgery: residual and recurrent disease a review of 1024 cases. Ann Otol Rhinol Laryngol 86:451–462
Tarabichi M (1997) Endoscopic management of acquired cholesteatoma. Am J Otol 18(5):544–549 (PMID:9303149)
Glasscock ME, Miller GW (1976) Intact canal wall tympanoplasty in the management of cholesteatoma. Laryngoscope 86:1639–1657
Morimitsu T, Tono T, Makino K, Miyanaga S, Ushisako Y (1995) Improvement of thesurgical technique of anterior tympanostomy in cholesteatoma. Rev Laryngol Otol Rhinol (Bord) 116:369–371
Palva T, Ramsey H, Bohlurg J (1998) Lateral and anterior view to tensor fold and supratubalrecess. Am J Otol 19(4):405–413 (PMID:9661747)
Tarabichi M (2004) Endoscopic management of limited attic cholesteatoma. Laryngoscope 114(7):1157–1162
Daniele M, Francesco M, Matteo A, Livio P (2009) Endoscopic approach to tensor fold in patients with attic cholesteatoma. Acta Oto Laryngologica 129:946–954
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There was no conflict of interest and no funding was received for the research.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Prior approval from ethical committee of the institute was taken.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Nandyal, C.B., Sutrave, M., Kurle, V. et al. Mrmc Neo Surgical Ventilating Port and Neo Attic Malleo-Incudal Complex in Endoscopic Management of Limited Attico-Antral Cholesteatoma. Indian J Otolaryngol Head Neck Surg 70, 33–37 (2018). https://doi.org/10.1007/s12070-017-1202-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-017-1202-6