Attical cholesteatoma: endoscopic removal (transcanal approach) of cholesteatoma with total ossiculoplasty performed
A 19-year-old male addressed with complaints to a hearing loss at the left, existence of conductive relative deafness with an average air-bone gap of 20dB is revealed (with normal tympanic membrane condition). The gradual deterioration in hearing has developed within 3 years.
At CT temporal bones are revealed the symptoms of fibrosis which are localized in the superior and middle divisions of the tympanal cavity, and also incomplete visualization of incus and stapes at the left. The endoscopic operation on the left ear carried-out endomeatal-transtympanal approach has revealed the following:
• existence of gaping base of stapes, arch devoid;
• reject from an arch a head of stapes which together with tendon of the stapedius muscle were displaced to pyramidal eminence;
• lysis of the long process of the incus;
• dehiscence of the canal of the tympanic segment facial nerve;
• existence of cholesteatoma, which partially occupied as in an external, and internal attic, and also extended to some structures of middle divisions tympanic cavity - in tympanic mouth of the Eustachian tube and on a proximal part of tympanic segment facial nerve.
After removal of cholesteatoma focusing, fenestration of the stapes footplate is made with following total ossiculoplasty is performed.