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Management of attic retraction pockets

Published online by Cambridge University Press:  19 May 2023

Vijayendra Honnurappa ,
Nilesh Mahajan Open the ORCID record for Nilesh Mahajan [Opens in a new window] ,
Vinay Kumar Vijayendra ,
Sofia Vassiliu Open the ORCID record for Sofia Vassiliu [Opens in a new window]  and
Miriam Redleaf
Vijayendra Honnurappa
Affiliation:
Vijaya ENT Care Centre, Super Speciality Otology Centre, Bangalore, India
Nilesh Mahajan*
Affiliation:
Vijaya ENT Care Centre, Super Speciality Otology Centre, Bangalore, India
Vinay Kumar Vijayendra
Affiliation:
Vijaya ENT Care Centre, Super Speciality Otology Centre, Bangalore, India
Sofia Vassiliu
Affiliation:
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Miriam Redleaf
Affiliation:
Otology/Neurotology, Department of Otolaryngology, University of Illinois Hospitals, Chicago, USA
*
Corresponding author: Nilesh Mahajan; Email: nilesh.virtual@gmail.com
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Abstract

Objective

Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade.

Method

Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air–bone gap pure tone average were recorded.

Results

Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II–V ears had surgical management. All 200 ears were followed up for 36–240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air–bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter.

Conclusion

Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing.

Keywords

Cartilageear ossiclescholesteatomahearing

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1272 - 1276
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Nilesh Mahajan takes responsibility for the integrity of the content of the paper

References

Vijayendra, H, Mahajan, NH, Vijayendra, V, Ramdass, S. Attic retraction pockets: classification system. Laryngoscope 2020;130:2034–9CrossRefGoogle ScholarPubMed
Νankivell, PC, Pothier, DD. Surgery for tympanic membrane retraction pockets. Cochrane Database Syst Rev 2010;(7):CD007943Google Scholar
Park, M, Kim, CW, Park, SM, Lee, JJ, Kim, HS. Usefulness of attic reconstruction using tragal cartilage and perichodrium for prevention of a retraction pocket. Korean J Audiol 2011;15:124–8Google Scholar
Kasbekar, AV, Patel, V, Rubasighe, M, Srinivasan, V. The surgical management of tympanic membrane retraction pockets using cartilage. Indian J Otol Head Neck Surg 2014;66:449–54CrossRefGoogle ScholarPubMed
Comacchio, F, Mion, M, Pedruzzi, B. Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma. J Otol 2017;12:112–16CrossRefGoogle ScholarPubMed
Pappas, DG. Bondy's modified radical mastoidectomy revisited. ENT J 1994;73:15–18Google Scholar
Cross, JP. Homologous dura use in problem pocket repair. Laryngoscope 1984;94:919–22CrossRefGoogle ScholarPubMed
Marchioni, D, Alicandri-Ciufelli, M, Motelni, G, Genovese, E, Presutti, L. Endoscopic tympanoplasty in patients with attic retraction pockets. Laryngoscope 2010;120:1847–55CrossRefGoogle ScholarPubMed
Pfleiderer, AG, Ghosh, S, Kairinos, N, Chaudhri, F. A study of recurrence of retraction pockets after various methods of primary reconstruction of attic and mesotympanic defects in combined approach tympanoplasty. Clin Otolarygol Allied Sci 2003;28:548–51CrossRefGoogle ScholarPubMed
Honnurappa, V, Mahajan, N, Vijayendra, V, Ramdass, S, Redleaf, M. Unmitigated negative nasopharyngeal pressure is associated with attic retraction pocket formation: LaPlace's law in action. J Laryngol Otol 2021;135:1100–4Google Scholar
Marchioni, D, Villari, D, Mattioli, F, Alicandri-Ciufelli, M, Piccini, A, Presutti, L. Endoscopic management of attic cholesteatoma. Otolaryngol Clin North Am 2013;46:201–9CrossRefGoogle ScholarPubMed
Sade, J. Treatment of retraction pockets and cholesteatomas. J Laryngol Otol 1982;96:685–794CrossRefGoogle Scholar
Paparella, MM. Tympanoplasty for atelectatic ears. Laryngoscope 1979;89:1345–6CrossRefGoogle ScholarPubMed
Paparella, MM, Jung, TTK. Experience with tympanoplasty for atelectatic ears. Laryngoscope 1981;91:1472–7CrossRefGoogle ScholarPubMed
Wallenborn, PA. Surgical management of attic retraction and chronic adhesive otitis media. Va Med 1984;12:759–61Google Scholar
Sanna, M, Facharzt, AA, Russo, A, Lauda, L, Pasanisi, E, Bacciu, A. Modified Bondy's technique: refinements of the surgical technique and long-term results. Otol Neurotol 2009;30:64–9CrossRefGoogle Scholar
Tarabichi, M, Marchioni, D, Kapadia, M. The epitympanum revisited: endoscopic anatomy. Indian J Otolaryngol Head Neck Surg 2016;68:490–5CrossRefGoogle ScholarPubMed
Marchioni, D, Alicandri-Ciufelli, M, Molteni, G, Artioli, FL, Genovese, E, Presutti, L. Selective epitympanic dysventilation syndrome. Laryngoscope 2010;120:1028–33CrossRefGoogle ScholarPubMed