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. 2023 Jan;280(1):131-136.
doi: 10.1007/s00405-022-07465-w. Epub 2022 Jun 13.

Variability of the retrotympanum and its association with mastoid pneumatization in cholesteatoma patients

Sara-Lynn Hool  1 , Sven Beckmann  2 , Arsany Hakim  3 , Abraam Yacoub  1   4 , Marco Caversaccio  1 , Franca Wagner #  3 , Lukas Anschuetz #  1
Affiliations

Variability of the retrotympanum and its association with mastoid pneumatization in cholesteatoma patients

Sara-Lynn Hool et al. Eur Arch Otorhinolaryngol. 2023 Jan.

Abstract

Purpose: This study aimed to investigate the variability of the retrotympanum in patients undergoing surgical treatment for cholesteatoma.

Methods: We included 59 ears of patients undergoing middle ear surgery for cholesteatoma who had preoperative computed tomography scans. A retrospective analysis of the medical records was conducted. The sinus tympani (ST), subtympanic sinus (STS) and facial recess (FR) were classified into types A-C based on the relationship of their extension to the facial nerve. The mastoid and petrous apex were assessed and categorized as normal pneumatized or sclerotic.

Results: Type A extension was the most frequently found in all sinuses (ST 64%, FR 77%, STS 69%), Type B extension was found more often in ST (34%) and STS (24%) than in FR (15%). A very deep extension was found only rarely (ST 2%, FR 8%, STS 7%). A sclerotic mastoid was found in 67% of cases. Those cases showed a statistically significant difference regarding retrotympanum pneumatization when compared with normal mastoid.

Conclusion: The most frequent variant of retrotympanic pneumatization in relation to the facial nerve was type A in all subsites in cholesteatoma patients. The variability among patients with cholesteatoma is different to previously published results in healthy subjects. Moreover, the pneumatization of the retrotympanum is associated with mastoid pneumatization.

Keywords: Cholesteatoma; Endoscopic ear surgery; Pneumatization; Retrotympanum; Temporal bone anatomy.

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Conflict of interest statement

L. Anschuetz is a consultant physician for STRYKER ENT. He has not received any financial compensation for his contribution to this manuscript.

Figures

Fig. 1
Fig. 1
Left ear: Schematic illustration of the anatomy of the retrotympanum. In incus, fp footplate, fn facial nerve, pr promontory, PS posterior sinus, po ponticulus, su subiculum, pe pyramidal eminence, rw round window, FR facial recess, ST sinus tympani, fu fustis, STS subtympanic sinus, fi finiculus
Fig. 2
Fig. 2
Radiologic classification of retrotympanum in Type A/B/C: Facial recess (A/D/G), sinus tympani (B/E/H) and subtympanic sinus (C/F/I). *Facial nerve
Fig. 3
Fig. 3
Radiologic distribution of retrotympanic sinus configuration in cholesteatoma cases
Fig. 4
Fig. 4
A Association of sclerotic mastoid and retrotympanum pneumatization. Type A configuration of all sinuses was found statistically significantly more often than in normal pneumatized mastoid. B Distribution of retrotympanum pneumatization in normal mastoid
See this image and copyright information in PMC

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