Spontaneous atticotomy.

The otoscopic view is that of the left ear of a 45-year-old woman who was asymptomatic (figure). A wide atticotomy was discovered during a general medical check-up. The tympanic membrane was in its normal position and was mildly scarred. Some epithelial flakes had migrated at the level of the posterosuperior border of the atticotomy. The cavity otherwise appeared to be free of any retained debris. The patient had a history of otitis during childhood. Her heating was normal.

The supposition is that recurrent inflammatory episodes led to the progressive destruction of the scutum. The favorable evolution of this inflammation could be considered to represent a spontaneous cure, for which no surgical treatment is indicated. However, it is wise to obtain computed tomography to verily the size of the cavity and the status of the mastoid, which is very likely to be sclerotic. The patient should be advised to undergo an annual ear evaluation to detect possible accumulation of ceruminous or epithelial debris.

From the Pulec Ear Clinic, Los Angeles (Dr. Pulec), and Gap, France (Dr. Deguine).

Jack L. Pulec The late Dr. Pulec was editor-in chief of Ear, Nose & Throat Journal from 1992 through 2003.