Ossicular Erosion and Air-Bone Gap in Attic and Tensa Cholesteatomas

Abstract

Objectives:

(1) Compare the air-bone gap between patients with posterior epitympanic (attic) and posterior mesotympanic (tensa) cholesteatomas. (2) Correlate the air-bone gap and intraoperative ossicular chain findings.

Methods:

Cross-sectional study. In total, 262 patients with attic and tensa cholesteatomas treated at a tertiary hospital were included. Audiometry was performed, and the pure tone average air-bone gap (PTA-ABG) was compared between the 2 groups. In addition, ossicles were classified as normal, eroded, or absent based on intraoperative evaluation. Data were compared using the Mann-Whitney and Chi-square tests, and statistical analysis was performed using SPSS.

Results:

Attic cholesteatoma was diagnosed in 51.1% of patients and tensa cholesteatoma in 48.9%. The mean patient age was 33 ± 18.7 years, and 52.3% were male patients. The PTA-ABG was higher in tensa cholesteatoma cases than in attic cholesteatoma (30.25 ± 12.82 dB and 26.73 ± 13.08 dB, respectively, P = .031). There were no differences in the malleus erosion or absence prevalence and the stapes suprastructure prevalence (P = .09 and P = .17, respectively). The incus was normal in 17.6% of the attic and 6.3% of tensa cholesteatoma cases; eroded in 79.4% of tensa and 48.6% of attic cases; and absent in 33.8% of attic and 14.3% of tensa cholesteatoma cases (P < .01).

Conclusions:

The PTA-ABG was higher in tensa cholesteatoma cases and correlated with a lower normal incus prevalence and a higher eroded incus prevalence compared to attic cholesteatoma cases.