One Stage Canal Wall Up Tympanoplasty with Attic Reconstruction Assisted with Otoendoscope for a Small Attic Cholesteatoma

Abstract

We have performed canal wall up tympanoplasty for middle ear cholesteatoma assisted with otoendoscope for the past six years. According to our results, one-stage operation with attic reconstruction using auricular cartilage and bone pate has been applied to patients with a small attic cholesteatoma not extending to the mastoid cavity. This paper describes the surgical indication, procedure, and outcome of the one-stage operation.A control hole for endoscopic exploration is made in the mastoid cavity. Reconstruction of the attic defect with a few pieces of thinly-sliced auricular cartilage and bone pate is done following transcanal removal of the cholesteatoma matrix in the case of aerated mastoid cavity without inflammation. The ossicular chain is also reconstructed if involved. The control hole is closed with bone pate. Second-look operation is not necessary if CT scan reveals no residual disease. We applied the one-stage operation to 30 patients between 1998 and 2003. Out of the 23 cases followed over two years, recurrence from the attic pocket was seen in only one case.