Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma

Abstract

Background

We devised a surgical technique called ‘atticosinuplasty’ (AS) for the treatment of early-stage cholesteatoma.

Objective

This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma.

Materials and Methods

A total of 187 patients with either AS (n = 89) or CWU (n = 98) were compared in terms of postoperative hearing outcome, recurrence and re-operation rate, and radiologic outcome.

Results

Hearing gain was significant in the AS group (p < 0.001) but not in the CWU group. Air conduction change, air–bone gap (ABG) change, and ABG closure did not significantly differ between the two groups. The frequencies of cholesteatoma recurrence and revision ossiculoplasty were also similar. Of the 32 patients in the AS group with only attic/sinus involvement preoperatively, 20 (62.5%) showed no haziness and 6 (18.8%) had haziness extending to the mastoid postoperatively. Among the 67 patients in the CWU group who had haziness extending to the mastoid preoperatively, in 54 (80.6%) there was no change postoperatively.

Conclusions and Significance

AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

Chinese Abstract

背景：我们设计了一种称为“顶室窦成形术”（AS）的手术方法来治疗早期胆脂瘤。

目的：本研究通过与管壁乳突切除术（CWU）相比较, 分析了AS 对早期胆脂瘤患者的适当性和适用性。

材料和方法：对 187 名 AS (n = 89)手术 或 CWU (n = 98) 手术的患者的术后听力结果、复发和再手术率以及影像学结果进行了比较。

结果：AS 组的听力增益显著（p < 0.001）, 而 CWU 组则不显著。气导变化、气骨间隙 (ABG) 变化和 ABG 闭合在两组之间没有显著差异。胆脂瘤复发和再行听骨成形术的频率也相似。在术前仅累及顶室/窦的 AS 组 32 例患者中, 20 例（62.5%）没有显示模糊感, 6 人（18.8%）在术后其模糊感延伸至乳突。CWU 组 67 例患者术前模糊延伸至乳突, 54例(80.6%) 术后无变化。

结论与意义：对于顶室/窦胆脂瘤患者, 从复发率和听力改善的角度来说, AS不失为一种值得尝试的手术方法。

Keywords:

• Cholesteatoma
• atticosinuplasty
• mastoidectomy
• attic
• sinus

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This work was supported by A Korean Medical Device Development Fund grant funded by the Korea government [grant number KMDF_PR_20210527_0007_2021_02].