PubMed · 14054628
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J R LINDSAY. 1963. MASTOIDITIS.. https://pubmed.ncbi.nlm.nih.gov/14054628/
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The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption. This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.
OBJECTIVE: To observe the effects of lateral attic wall reconstruction and sealing of attic cell in prevention of recurrence of cholesteatoma and limitation of ossicular chain after tympanoplasty. METHODS: 150 cases of chronic tympanitis and mastoiditis were studied. Forty patients with intact ossicular chain after opening mastoidectomy underwent lateral attic wall reconstruction with autologous cartilage of auricular concha (n = 15) or "bone cement plate" made of autologous bone cortex powder adhered by glue of fibrinogen and thrombin (n = 25). Eighty-nine of the 110 cases with damaged ossicular chain underwent reconstruction of ossicular chain and sealing of tympanic cavity with bone powder and glue of fibrinogen and thrombin and fascia of temporal muscle was used to restore the tympanic membrane in 21 of them. Follow-up was conducted for 3 to 5 years to observe the recovery of tympanic membrane, hearing, and whether cholesteatoma recurred. RESULTS: No recurrent cholesteatoma and serious retracted tympanic membrane were found. Eardrum re-perforated in 8 cases (5.33%). The patients with lateral attic wall reconstruction obtained a significant hearing improvement (97.5%). Hearing was improved among 80.8% of the cases that underwent sealing of attic cell and ossiculoplasty. CONCLUSION: Lateral attic wall reconstruction and sealing of attic cell prevent the recurrence of cholesteatoma. Reconstruction of lateral attic wall provides a new space for vibration of ossicular chain.