We reviewed 18 patients with 20 involved ears who had undergone transmeatal atticotomy for attic cholesteatoma and then were followed for 1 to 7 years (mean =3.5 years) in our department. From the results analyzed with special reference to postoperative recurrence of cholesteatoma, the indications for atticotomy to treat attic cholesteatoma were evaluated.
Of 20 ears,14 ears (70%) have remained free of disease since surgery. Four ears (20%)developed attic retraction pocket and three of the ears finally developed recurrent cholesteatoma, and two ears (10%) have been wet with crust or granulation formation. Recurrent cholesteatoma can occur when an attic retraction pocket develops again after the procedure, because simple atticotomy has no influence on pathogenesis of attic cholesteatoma. Taking the age, hearing level and local findings of patients into consideration, therefore, we concluded that atticotomy is an appropriate indication for attic cholesteatoma under the following conditions: 1) when all the pathogenic processes of attic cholesteatoma have already disappeared, and 2) or when the mastoid is sclerotic, and the mastoid and antrum have no more space for retraction pocket even if the pathogenic processes of attic cholesteatoma have not yet disappeared.