A prospective study on the clinical outcomes of scutumplasty in cases of attic cholesteatoma

Abstract

Introduction: Cholesteatoma is a cystic lesion formed from keratinising stratified squamous epithelium, the matrix of which is composed of epithelium that rests on a stroma of varying thickness, the perimatrix. The resulting hyperkeratosis and shedding of keratin debris usually results in a cystic mass with a surrounding inflammatory reaction. Prussac’s space is the site of origin of acquired cholesteatoma. It can later spread into mastoid cavity and mesotympanum and destroy the ossicles and induce complications. Materials and Methods: This was a prospective interventional study which was done in the Department of ENT, Santhiram Medical College and General Hospital, Nandyal from January 2017 to December 2019. 100 cases (48 males, 52 females) with attic cholesteatoma with eroded scutum were enrolled in the study and scutumplasty was performed after history taking and thorough clinical (Local & systemic) examination. Surgery was conducted in strict aseptic environment. Results: The mean preoperative and postoperative air-bone gaps were 36.8±14.8 dB and 27.1±11 dB, respectively (p=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5±9.7 dB and 15.23±14.0 dB, respectively (p=0.411). Postoperative retraction occurred in 16% of patients and recurrent cholesteatoma was detected in 3 cases (6%) for which revision surgery was performed. Conclusion: Scutumplasty showed a low disease recurrence rate and no deterioration in hearing levels. With intact malleus head or body of incus, attic reconstruction was possible and this procedure lead to improved hearing. However, a problem that still needs to be addressed in future is postoperative retraction.