Abstract

Objectives: Patients with extended cholesteatoma who underwent Combined Heermann And Tos (CHAT) technique, which we developed depending on our studies on Heermann’s “cartilage palisade tympanoplasty“ and Tos’ “modified combined approach tympanoplasty“, were analyzed.

Patients and Methods: The study included 37 ears of 35 patients, in whom CHAT technique was performed. Posterior-superior bony annulus was widely drilled, transmeatal atticotomy and cortical mastoidectomy with preservation of posterior ear canal wall were performed in each patient. After ossiculoplasty, perforation of the eardrum, opening at bony annulus and scutum were reconstructed with the palisade technique. At the final evaluation, otoscopic and audiologic findings were evaluated and compared (Paired Sample t-test).

Results: Median age was 33 (6-57), mean follow-up period was 30 months (range: 6-60; standard deviation: 19). There was no complication in any patient before or after the surgery. There was two (5%) recurrent cholesteatomas (eradication: 95%), one of which was local. The mean hearing and air-bone gap preoperatively versus in last evaluation were 45 (standard deviation: 14) vs 35 dB (standard deviation: 16) (p<0.0001) and 29 (standard deviation: 11) vs 21 dB (standard deviation: 11), respectively (p<0.001).

Conclusion: We conclude that CHAT technique is quite successful in the eradication of extensive cholesteatoma with satisfactory results in hearing, although it is a one-stage, canal wall up closed technique.