The study of outcomes of atticoantrostomy with lateral attic wall reconstruction

Abstract Background Surgical management of chronic otitis media (COM) often requires mastoidectomy, performed either as a canal wall up (CWU) or canal wall down (CWD) procedure. Atticoantrostomy is a CWD mastoidectomy in which the facial ridge is preserved and the lateral attic wall is reconstructed, commonly with conchal cartilage so as to maintain epitympanic aeration, improve hearing, and minimise cavity-related problems. Methods This prospective observational study was conducted at a tertiary care centre in Mumbai, India, and included 30 adult patients with limited attico-antral disease operated between January 2021 and September 2021. All patients underwent atticoantrostomy with lateral attic wall reconstruction using conchal cartilage, with ossiculoplasty (Teflon TORP or PORP or cartilage) performed as required based on intraoperative ossicular status. Outcomes assessed were disease clearance and hearing improvement (subjective and by pure tone audiometry). Results The most affected age group was 18–20 years (43.4%), with a mean age of 25.7 years; 53.3% of patients were male. The right ear was operated in 56.7% of cases. At presentation, 56.7% had severe conductive hearing loss (CHL), 30.0% moderate CHL, 10.0% mild CHL, and 3.3% had normal hearing. Type 3 ossiculoplasty was most common (66.7%), followed by Type 2 (30.0%) and Type 4 (3.3%); TORP was used in 46.6%, PORP in 36.8%, and conchal cartilage in 16.6%. At 3-month follow-up, 66.6% had a well-healed tympanic membrane, 13.3% showed residual disease on imaging, and 3.3% had a residual perforation. At 6 months, 60.0% had a completely healed tympanic membrane, 6.7% had a healed tympanic membrae with narrowed meatus, 16.6% had Grade II–III tympanic membrane retraction, and 16.7% required revision surgery. Hearing outcomes improved significantly: severe CHL decreased from 56.7% pre-operatively to 16.7% post-operatively, with a corresponding increase in mild and moderate CHL categories (chi-square X² = 11.05, p = 0.011). Conclusion In this small prospective single-centre series, atticoantrostomy with lateral attic wall reconstruction using conchal cartilage allowed adequate disease clearance and achieved favourable short-term hearing and avoided cavity problems. Larger comparative studies with a group of patients undergoing modified radical mastoidectomy and longer follow-up are required to evaluate long-term outcomes.