Long-term outcome of atticotomy for cholesteatoma in children.

OBJECTIVE To evaluate the long-term outcome of atticotomy (AT) surgery for cholesteatoma in children. STUDY DESIGN Case series, retrospective chart review. SETTING General otology practice in a teaching hospital. PATIENTS Fifty-three children aged 5 to 16 years old with cholesteatoma limited to the attic and middle ear who underwent AT between the years 1979 to 1994. INTERVENTIONS AT consisting of removal of cholesteatoma confined mainly to the attic. The procedure consists of removal of the lateral attic wall (scutum) and involved ossicles with excision of the cholesteatoma and tympanic membrane grafting with temporalis fascia, leaving a small attical cavity. The mastoid antrum was left intact. MAIN OUTCOME MEASURES Disease recurrence, middle ear status, hearing results, and the need for further surgery. RESULTS Mean follow up was 5.1 (+/-3.6) years. Eleven (21%) children required completion canal wall down tympanomastoidectomy because of residual disease or recurrence. The mean preoperative speech recognition threshold was 39.4 +/- 13.4 dB. The mean postoperative speech recognition threshold was 34.5 +/- 15.4, an improvement of 6.1 dB compared with the preoperative level. Last follow-up examination revealed a dry ear in all cases but one. CONCLUSIONS In selected cases, AT can be a less invasive option in children with cholesteatoma limited to the attic and middle ear.