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Updated: Jan 2, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
A tiny retraction of the pars flaccida may conceal an attic cholesteatoma
Geon Woo Kim1, Hwi Kyeong Jung1, Jae Moon Sung1
1Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Hallym University, 445 Gil-Dong, Gangdong-gu, Seoul, 134-701, Korea.
Objective:
The purpose of this study was to evaluate the possibility of attic cholesteatomas concealed within a tiny retraction of the pars flaccida (classification of Tos and Poulsen type I or II attic retraction) in patients with an intact pars tensa of the tympanic membrane.
Methods:
The clinical records of patients with a tiny retraction of the pars flaccida and an intact pars tensa of the tympanic membrane who presented to the ear clinic of a tertiary care medical center for the first time between March 2012 and February 2015 were retrospectively reviewed. All patients who had an abnormal pars flaccida of the tympanic membrane were recommended to undergo temporal bone computed tomography (CT) scans. In cases of a soft tissue density lesion within Prussak's space, an exploratory operation was recommended.
Results:
Among 1320 adult patients, 146 patients (n = 168 ears) who had a tiny attic retraction with a normal pars tensa in unilateral or bilateral ears underwent temporal bone CT scans, and 18 ears had a soft tissue density lesion within Prussak's space. Among the ears with a tiny retraction of the pars flaccida and a normal pars tensa, an attic cholesteatoma was suspected in 10.7% (n = 18 ears) of cases based on the CT scans. After exploratory operations, 2% of patients who underwent CT scans (3 out of 146 patients) and 23% of patients who had a soft tissue density lesion within Prussak's space on CT scans (3 out of 13 operations) had an attic cholesteatoma.
Conclusion:
All attic retractions which are even in cases of Tos type I or II should be examined closely using endoscopy, microscopy, and, if necessary, temporal bone CT scan.
Insights
Tiny ear retractions can hide attic cholesteatomas. Even small attic retractions (Tos type I or II) warrant close examination with imaging like temporal bone CT scans to detect potential cholesteatomas.
Area of Science:
- Otolaryngology
- Medical Imaging
- Surgical Pathology
Background:
- Attic cholesteatomas can be concealed within subtle pars flaccida retractions.
- Early detection is crucial for effective management of middle ear pathologies.
Purpose of the Study:
- To evaluate the potential for attic cholesteatomas in patients with minimal pars flaccida retractions (Tos type I or II).
- To assess the diagnostic utility of temporal bone CT scans in identifying these concealed cholesteatomas.
Main Methods:
- Retrospective review of clinical records for patients with tiny pars flaccida retractions and intact pars tensa.
- Performance of temporal bone computed tomography (CT) scans for abnormal pars flaccida.
- Recommendation for exploratory surgery based on CT findings of soft tissue density in Prussak's space.
Main Results:
- Out of 1320 adult patients, 146 (168 ears) with tiny attic retractions underwent CT scans.
- CT scans suspected attic cholesteatoma in 10.7% (18 ears) of cases with tiny retractions.
- Exploratory surgery confirmed attic cholesteatoma in 2% of all CT-scanned patients and 23% of those with CT-identified lesions in Prussak's space.
Conclusions:
- Minimal attic retractions (Tos type I or II) require thorough investigation.
- Endoscopy, microscopy, and temporal bone CT scans are recommended for evaluating these subtle findings.
- Prompt diagnosis and intervention are essential for managing potential attic cholesteatomas.
