Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears.

INTRODUCTION AND OBJECTIVES: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. MATERIAL AND METHODS: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. RESULTS: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). CONCLUSIONS: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attic cholesteatoma.