Anatomical and Hearing Outcomes of Endoscopic Assisted Atticotomy with Cartilage Tympanoplasty in Cases of Limited Mastoid Disease

Objective: To study the anatomical and hearing outcomes in endoscopic assisted atticotomy with cartilage tympanoplasty in patients with limited mastoid disease (involving attic, antrum). Material and methods: Study was conducted in a tertiary care referral hospital between July 2012 and April 2015. Total 28 patients with limited mastoid diseases were included in the study. All underwent endoscopic assisted atticotomy and cartilage tympanoplasty. Patients were evaluated at 3 months, 6 months and 12 months after surgery to assess the graft uptake and hearing outcome. In postoperative period, ≥10 dB closure of air bone gap was considered significant improvement in hearing. Result: Of 28 patients, cholesteatoma involving attic was found in 13(45%) patients, posterorsuperior mesotympanum in 7(25%) patients and 8(30%) patients presented with attic retraction. Out of 28 patients, 8(28.57%) were undergone type I tympanoplasty, 16(57.14%) were undergone type IIIB tympanoplasty and 4(14.28%) were undergone type IIIC tympanoplasty. The mean AB closure were 11.13 dB, 9.56 dB, and 8.0 dB in type I, type IIIB and type IIIC cartilage tympanoplasty respectively after 12 months. 75% of patients with type 1 tympanoplasty, 6(37.50%) patients with type IIIB tympanoplasty showed significant improvement in hearing (≥10.00 dB). 2 patients had residual perforation after 3 months of surgery and none of them had postoperative retraction. Conclusion: Atticotomy supplemented with otoendoscopy is an effective surgical technique for the management of limited mastoid disease and autologous conchal cartilage is an ideal autograft considered for the reconstruction of the attic and for cartilage tympanoplasty associated with satisfactory outcomes.