Type III: Large defects of the malleus and incus warrant the removal of the ossicular chain and of the
epitympanum. The tympanic membrane must be directly connected with the head of the stapes.
(2011) SAC classification Initial location of cholesteatoma Pars flaccida cholesteatoma (attic or Prussak's space)
Epitympanum (lateral to ossicle) Cholesteatoma with pars tensa type perforation (sinus) Mesotympanum (medial to ossicle) Ad hoc group (mural cholesteatoma/auto-atticotomy) Undefined Total SAC classification Number of ears (%) Pars flaccida cholesteatoma (attic or Prussak's space) 36 (48.0%) Cholesteatoma with pars tensa type perforation (sinus) 24 (32.0%) Ad hoc group (mural cholesteatoma/auto-atticotomy) 15 (20.0%) Total 75 SAC, secondary acquired cholesteatoma Table 2.
Tubotympanic chronic otitis media tends to be typified by disease of the pars tensa and mesotympanum, whereas atticoantral disease primarily involves the pars flaccida and
epitympanum [3].
Intraoperatively, a tumor was found to occupy the entire
epitympanum and mesotympanum with extension into the hypotympanum.
The tympanic membrane was normal anteriorly, but posteriorly the drum was displaced laterally by tumor in the middle ear, which extended up into the
epitympanum and back into some of the mastoid air cells.
An urgent computed tomography (CT) scan of the brain and temporal bones was requested, revealing an opacified middle ear and
epitympanum. An extensive thrombus was seen in the right transverse dural sinus (Fig.
Current-generation CT has allowed increased resolution of the structures within the temporal bones and is now considered the investigation of choice7.Congenital cholesteatoma originate from embryonic epithelial remains, tend to occur in the anterior tympanic cavity, proximal to the
epitympanum or stapes8.
Pars flaccida cholesteatomas are the most common and begin along the pars flaccida, grow into the
epitympanum in Prussak's space (attic cholesteatomas), lateral to the ossicular chain.
HRCT provided useful information for cholesteatoma operating surgeon as degree of ventilation/opacification of middle ear cleft from the Eustachian tube to the mastoid tip, erosion of ossicular chain, access to the
epitympanum as determined by the level of the dura laterally, development/cellularity/ sclerosis of the mastoid cortex, dehiscence of the tegmen, erosion of the labyrinth, especially the lateral semicircular canal and status of the facial nerve.
1) that had engulfed the
epitympanum with extrusion through the aditus ad antrum into the mastoid air cells.
Site: (a) Lateral attic (with anterior
epitympanum) and (b) Medial attic.
There are also cases of pathology of the first or second ossicles, leading to immobilization of the
epitympanum. Typically, there is increased vascularity of the lining of the tympanic cavity, which can often lead to severe bleeding during surgical maneuvers performed in the cavity [2, 5-12].