PubMed · 9522317
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G Geyer, J Helms. 1998. [Reconstructive interventions].. https://pubmed.ncbi.nlm.nih.gov/9522317/
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We performed tympanoplasty with reconstruction of the soft posterior meatal wall for the prevention of post-operative retraction pocket formation. Our method is characterized by the reconstruction of the soft posterior meatal wall, non-obliteration with permanent or temporary materials, including Gelfoam, no use of a Palva flap and the use of fibrin glue for attaching the fascia to the posterior meatal skin. None of the patients experienced post-operative narrow-neck retraction pocket formation, and whenever aeration of the middle ear was disturbed, a balloon-like retraction was observed. Not all the posterior meatal walls retracted. The final position of the posterior meatal wall varied among the subjects. No serious cavity or hearing problems have occurred since surgery. Due to the strong possibility of post-operative retraction pocket formation in cases with a large balloon-like retraction, we rejected adopting the canal wall up technique or hard posterior meatal wall reconstruction.
Several authors have confirmed that it is entirely reasonable to perform a one-stage atticotomy for attic cholesteatomas which are limited in size. Over a period of 10 years, 195 primary procedures were performed for cholesteatoma, and, out of this total, 65 were operated on by an established technique of cartilage repair. In this group of a limited atticotomy there were only two recurrences (3%) and so the technique is considered reliable and, furthermore, using the author's modification, there is no need to dissect out perichondrial flaps. It is recommended that attic cholesteatomas are operated on while they are as small as possible--no damage to the hearing occurred in 63 (96.9%) of the ears in this series--as the results of ossicular repair in ears damaged by cholesteatoma are unpredictable, especially when there is eustachian tube dysfunction.