Postauricular Approach Atticotomy: A Modified Closed Technique with Reconstruction of the Scutum with Cymbal Cartilage

Objectives: We studied the results of postauricular approach atticotomy in patients with cholesteatoma of the anterior epitympanum. Methods: Twenty-six patients were selected for removal of cholesteatoma of the anterior epitympanum by postauricular approach atticotomy, a closed transcanal procedure that is used to expose and remove cholesteatoma. After removal of cholesteatoma, reconstruction of the scutum is performed with cymbal cartilage. Results: Postauricular approach atticotomy can be performed as part of a canal wall–up procedure in selected cases in which cholesteatoma invades the anterior epitympanum. Especially if the ossicular chain is intact and if there is an anteriorly curved medial outer canal wall, this technique is useful in avoiding an open technique. A second-look procedure is recommended because of a relatively high percentage of recurrent and residual disease. Conclusions: Postauricular approach atticotomy with reconstruction of the scutum is a useful technique to remove cholesteatoma from the anterior epitympanum.