Endoscopic Management of Attic/ Antral Cholesteatoma and Ossiculoplasy

By June 6, 2019

Abdurehim, Yasin1
1 First Teaching Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China;
2 Department of Otolaryngology – Head and Neck Surgery, Urumqi, Xinjiang, China.

A 43 year-old female patient with long period of purulent otorrhea and hearing loss was admitted. A perforation in the pars-flacidda of tympanic membrane was noted, and a large air-bone gap was revealed in pure tone audiometry exam.

Endoscopic exploration of the middle ear was performed. After removal of the scutum with a chisel, attic and antral cholesteatoma sac was discovered. Tympanic isthmus was totally blocked.  Except an intact stapes, all other parts of the ossicular train was eroded. All the active disease was cleaned. Ossicular train was reconstructed by PORP, the missing part of scutum was rebuilt by cartilage graft, tympanoplasty was performed by underlay technique with a piece of perichondrium.

Six weeks later, the patient was seen with a very well healed tympanic membrane claiming her hearing was improved dramatically. Hearing test showed an almost closed air-bone gap.

Conclusion: EES was a minor invasive mothed for attic and antral lesions. Chisel is a safe and effective tool for removal of scutum during EES.