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Chronic Otitis Media
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
George G. Browning, Justin Weir, Gerard Kelly, Iain R.C. Swan
The pathogenesis of cholesteatoma is due either to the retraction of Shrapnell’s membrane (pars flaccida) or the posterior superior quadrant of the pars tensa, or to retraction of the entire pars tensa56,57 – the so-called ‘retraction pocket theory’ first described by Bezold in 1890.58 This was developed by Sudhoff and Tos59 who proposed a combined retraction and proliferation model. Key to this theory is Eustachian tube dysfunction which leads to retraction of the pars flaccida into the epitympanum, and subsequent cholesteatoma formation.60,61
Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma
Published in Acta Oto-Laryngologica, 2022
Jeong Hun Jang, Oak-Sung Choo, Hantai Kim, Hun Yi Park, Yun-Hoon Choung
Acquired cholesteatoma is divided into two types according to the pattern of expansion: attic cholesteatoma, originating from Shrapnell’s membrane and extending into the attic, and sinus cholesteatoma, originating from the postero-superior retraction of the pars tensa and extending into the tympanic sinuses. Acquired cholesteatoma usually involves the mastoid cavity laterally and the mesotympanum medially. When cholesteatoma involves the temporal bone, it can only be treated surgically. The surgical technique depends on the extent of the disease. Conventionally, the main surgical procedures have been canal wall-down mastoidectomy (CWD) and canal wall-up mastoidectomy (CWU); the rate of residual cholesteatoma is 2.38–8% and 2.2–43%, respectively [1–4], although the postoperative hearing status achieved with the two procedures is similar [5,6]. Modified techniques have been introduced to improve the surgical results, such as intact bridge mastoidectomy, which has a recurrence rate of 7.0% [7], and epitympanoplasty with mastoid obliteration, which according to one report was associated with no retraction pocket and no recurrence of cholesteatoma after > 5 years [8].