Attic Retraction Pocket Cholesteatoma
Tympanic Membrane Retraction Classification Note Sade Grade 3 Retracted Tympanic Membrane Touching Promontory Toss Grad Membrane Sade Classification
Capital Region Special Surgery Middle Ear Cochlear Implant Ear
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Otitis Media Chronic
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Media Otitis Chronic
Mbbs Doctors Atticoantral Chronic Suppurative Otitis Media Otitis Otitis Media Chronic
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This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma.
Attic retraction pocket cholesteatoma. Persistent negative pressure in the attic region causes invagination of pars flaccida causing a retraction pocket. Often there is an accumulation of squamous debris within the pocket figure 6a b. Invagination of the tympanic membrane of the attic to form retraction pockets to be filled with desquamated epithelium and keratin to form cholesteatoma. There has been significant bone erosion of the ear canal wall above the eardrum.
Eustachian tube theory. This retraction pocket becomes later filled with desquamated epithelial debris which forms a nidus for the infection to occur later. It is hypothesized that blockade of the tympanic isthmus causes isolation of the attic and the adjacent middle ear spaces and that subsequent building up of the negative pressure in these spaces results in retraction of the pars flaccida leading to formation of attic retraction pockets and cholesteatomas. This is the most common and widely considered as the main reason for cholesteatoma.
Common organisms to infect this keratin debris are psuedomonas e. Although the pathogenesis of acquired cholesteatoma remains controversial the most widely accepted theory is the retraction pocket theory which states that dysfunction of the eustachian tube leads to the buildup of negative pressure in the middle ear such that a segment of the tympanic membrane most commonly the pars flaccida is drawn into the middle ear and becomes sequestered followed by accumulation of the trapped keratin. A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma. Such causes can include for example poor eustachian tube function which results in retraction of the ear drum and failure of the normal outward migration of skin.
Mccabe b sadé j and abramson m. Pathophysiology toss theory of invagination. An attic cholesteatoma is defined as an epidermoid cyst found in the attic. 1 attic retraction pocket cholesteatoma is clearly visualized white arrow.
The cyst slowly erodes bone and can cause facial paralysis hearing loss dizziness and if left untreated can slowly erode into the brain cavity. Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities such as metaplastic islands of the mucosa in chronic ears with central perforations. Eds aesculapius publishing company birmingham alabama pp. Retraction pockets a retraction pocket is an invagination of the tympanic membrane.
A recurrent cholesteatoma is a new cholesteatoma that develops when the underlying causes of the initial cholesteatoma are still present. Granulation tissue may arise from the mucosa adjacent to the cholesteatoma figure 6c. 1977 the significance of the retraction pocket in the treatment of cholesteatoma. In cholesteatoma first international conference.
To examine this theory computerized tomographic ct findings of these conditions were evaluated in a series of 53 ears with retractions of the pars flaccida attic retractions.
