Abstract

OBJECTIVE: This study aims to evaluate the clinical features of patients who underwent surgery for isolated attic cholesteatoma and were diagnosed with selective dysventilation syndrome (SDVS).

METHODS: Pre- and postoperative clinical data of 33 SDVS patients (20 males, 13 females; mean age 31.8 years; range, 17 to 56 years) operated on for isolated attic cholesteatoma between January 2016 and September 2017 were retrospectively examined and recorded. Mastoid development was evaluated from preoperative temporal bone computed tomography images. Pre- and postoperative first year pure tone audiometry test results were recorded. Based on intraoperative findings, patients were divided into three groups according to epitympanic diaphragm/attic aeration pattern. The data of these three groups were compared statistically.

RESULTS: There were 17 type A (tympanic istmus blockage+complete tensor fold), 10 type B (tympanic istmus blockage+attical vertical blockage+incomplete/complete tensor fold) and six type C (complete epidermization of the attic+complete tensor fold) patients. The most common complaint in all groups was otorrhea. In groups A and B, mild retraction was generally observed in the tympanic membrane, whereas advanced retraction was observed in group C (p=0.002). There was evident mastoid hypopneumatization in each group and mastoid development was significantly worse in group C (p=0.023). In addition, facial dehiscence and recurrence rates were significantly higher in group C (p=0.006, p=0.011, respectively).

CONCLUSION: Selective dysventilation in the epitympanum may cause chronic middle ear diseases such as cholesteatoma behind mild retraction. The mastoid hypopneumatization caused by dysventilation is also undeniable in triggering this condition. During the surgery, particularly in isolated epitympanum pathologies, epitympanic diaphragm should be carefully evaluated.