• Chronic inflammatory disease in the middle ear sometimes leads to retraction and perforation of the pars flaccida of the tympanum. These attic perforations, marginal in location, are more difficult to remedy than perforations of the pars tensa. The latter are characteristic of acute otitis, generally central in location, and likely to heal spontaneously in a few weeks.
Prophylaxis includes follow-up of all cases of acute otitis to make sure that treatment with sulfonamides and antibiotics is continued until the exudate in the middle ear is resolved completely. In cases of incomplete resolution or other longstanding disease resulting in marginal perforations, if there is persistent drainage with symptoms of extension to neighboring structures and evidence of cholesteatoma, surgery must be considered.
In four cases of chronic otitis persisting from 3 to 20 years there were marginal perforations. All were successfully treated by modified radical mastoidectomy with special attention to the ossicular chain. Audiograms showed that the severe hearing losses that were almost inevitable with older types of radical mastoid surgery were avoided in these cases.
Juers AL. CURRENT CONCEPTS OF CHRONIC ATTIC AND MIDDLE EAR DISEASENEW SURGICAL TECHNIQUE TO PRESERVE HEARING. JAMA. 1956;160(6):451–455. doi:10.1001/jama.1956.02960410027006
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