1 Department of Otolaryngology, National Defense Medical College, Saitama, Japan.
Early stage attic cholesteatoma is thought to be an ideal indication for transcanal endoscopic ear surgery (TEES). This pathology frequently involves intact occicular chain, and/or small air-bone gap in the audiogram, whose preservations are easier under endoscopic approach. However, opening the ventilation route at the anterior tympanic space i.e. epitympanic recess, under preservation of ossicular chain is technically difficult because these structures are behind the malleus head. In this presentation, I would like to introduce tips and surgical technique about opening of the anterior ventilation route with ossicular chain preservation.
Chisel and hammer are the key instruments to open protympanic space under ossicular chain preservation. Powered devices such as drill or ultrasonic instruments should be avoided to removal of the anterior part of scutum, for strong vibration may conduct to the inner ear via the lateral process of malleus. Gentle removal of the anterior part of scutum leads to easier manipulation of the anterior malleal fold and tensor tympani under endoscopic view.
By using this technique, restoration of the anterior ventilation route can certainly be performed with ossicular chain preservation. This procedure would contribute better results about hearing and low recurrence rate in the patients with early stage attic cholesteatoma.