Attic Retraction Pocket Cholesteatoma
Tympanic Membrane Retraction Classification Note Sade Grade 3 Retracted Tympanic Membrane Touching Promontory Toss Grad Membrane Sade Classification
Capital Region Special Surgery Middle Ear Cochlear Implant Ear
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Otitis Media Chronic
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Media Otitis Chronic
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Otitis Media Chronic
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Attic retraction pocket cholesteatoma. Common organisms to infect this keratin debris are psuedomonas e. 1977 the significance of the retraction pocket in the treatment of cholesteatoma. In contrast in the 25 cases with attic cholesteatomas these numbers decreased to 10 and 5 respectively and the lack of aeration of the attic was demonstrated in 15 of 25 60 of the cases. The cyst slowly erodes bone and can cause facial paralysis hearing loss dizziness and if left untreated can slowly erode into the brain cavity.
Pathophysiology toss theory of invagination. Granulation tissue may arise from the mucosa adjacent to the cholesteatoma figure 6c. Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications. In cholesteatoma first international conference.
Go to top a skin cyst caused by a long standing retraction pocket of the eardrum into the middle ear. Often there is an accumulation of squamous debris within the pocket figure 6a b. Invagination of the tympanic membrane of the attic to form retraction pockets to be filled with desquamated epithelium and keratin to form cholesteatoma. There has been significant bone erosion of the ear canal wall above the eardrum.
In three cases of cholesteatoma follow up ct revealed either growth of a cholesteatoma from a retraction pocket or development of a small. An attic cholesteatoma is defined as an epidermoid cyst found in the attic. A recurrent cholesteatoma is a new cholesteatoma that develops when the underlying causes of the initial cholesteatoma are still present. Eustachian tube theory.
Retraction pockets a retraction pocket is an invagination of the tympanic membrane. A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma. Such causes can include for example poor eustachian tube function which results in retraction of the ear drum and failure of the normal outward migration of skin. This retraction pocket becomes later filled with desquamated epithelial debris which forms a nidus for the infection to occur later.
Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities such as metaplastic islands of the mucosa in chronic ears with central perforations. Eds aesculapius publishing company birmingham alabama pp. In 26 of 28 ears with attic retraction pockets at least a portion of attic was aerated and in 22 of these 26 ears the mastoid antrum was also aerated. Although the pathogenesis of acquired cholesteatoma remains controversial the most widely accepted theory is the retraction pocket theory which states that dysfunction of the eustachian tube leads to the buildup of negative pressure in the middle ear such that a segment of the tympanic membrane most commonly the pars flaccida is drawn into the middle ear and becomes sequestered followed by accumulation of the trapped keratin.
This is a serious condition. Persistent negative pressure in the attic region causes invagination of pars flaccida causing a retraction pocket.
