Transcanal atticoaditotomy and transcortical mastoidectomy for cholesteatoma: The Farrior-Olaizola technique revisited

Conservative mastoid surgery in the management of middle ear cholesteatoma has been a subject of controversy for decades. Proponents of the combined-a pproach tympanoplasty for cholesteatoma do not entirely support the conserv ative approach in children, especially in the hands of an inexperienced sur geon. We describe here our experience with a modified technique of conserva tive mastoid surgery involving an atticoaditotomy and a separate simple mas toidectomy with lateral attic wall reconstruction (modified Farrior techniq ue) that can be relatively safely used in the majority of cases of chronic squamous otitis media, even in children. This was a prospective analysis of the therapeutic effects and benefits of the technique used in 103 cases of cholesteatoma at Staffordshire General Hospital from 1991 to 1997. The fol low-up was between 3 and 9 years. The study group consisted of 55 male pati ents and 48 female patients, including 28 children less than 16 years of ag e. The age ranges were 9 to 61 years in male patients and 10 to 48 years in female patients. After an audiological assessment, all patients underwent the described mastoid procedure, and some of them required revision surgery , mostly for a second look or for ossiculoplasty. The chief outcome measure s used were complete eradication of disease, incidence of disease recurrenc e, and restoration of hearing. The steps of the procedure, its pros and con s, and the results of the series are presented. Also discussed is an overvi ew of the literature pertaining to intact-canal wall mastoid surgery. Of th e 103 patients, only 3 had a recurrence of disease, and 9 patients showed n o hearing improvement. We conclude that this modified technique has several advantages over the previously described mastoidectomy procedures. It is a relatively simple and effective technique that can be performed even in ch ildren.