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Lateral Attic Reconstruction Technique: Preventive Surgery for Epitympanic Retraction Pockets

Barbara, Maurizio

doi: 10.1097/MAO.0b013e318170b623
Middle Ear and Mastoid Disease

Objective: To provide an estimate of the reliability of a preventive surgical approach named lateral attic reconstruction (LAR) technique for the treatment of Type II epitympanic retraction pockets.

Study Design: From a cohort of 25 adult patients presenting with a Type II epitympanic retraction pocket, 2 groups were randomly formed: a first one, with 15 patients who underwent LAR technique, and a second one, in whom (10 patients) only observation was planned and was therefore used as control.

Setting: University hospital as tertiary referral center.

Patients: Selection criteria for composing the 2 groups of study were the presence of a Type II epitympanic retraction pocket and a normal audiogram.

Intervention(s): The surgical procedure (LAR) consisted of a retroauricular approach, removal of a small piece of tragal cartilage, cleansing of the epitympanic pocket until denudation of the ossicular components, and placement of the cartilage graft to reconstruct the lateral epitympanic wall.

Main Outcome Measure(s): All the patients were controlled at different postoperative or postobservation times (1, 3, 6, and 12 mo) via otomicroscopic examination, pure-tone audiometry, and tympanometry.

Results: All operated patients showed a normal anatomic pattern starting from the first postoperative control (1 mo) with a normal or near-normal hearing threshold and a Type A or As tympanogram in most cases.

Conclusion: Lateral attic reconstruction technique has proved to be a reliable preventive technique for impeding a Type II epitympanic retraction pocket to worsen because it was observed in a percentage, although small (33.3%), of patients in whom a wait-and-scope policy was applied.

Department of Otorhinolaryngology, University La Sapienza, II Medical School, Rome, Italy

Address correspondence and reprint requests to Maurizio Barbara, M.D., Ph.D., Department of Otorhinolaryngology, University La Sapienza, II Medical School, Azienda Ospedaliera Sant'Andrea, Via di Grottarossa 1035, 00197 Rome, Italy; E-mail:

© 2008 Otology & Neurotology, Inc.