An adult patient presenting with sudden onset pain in the 8th year of cochlear implantation will be discussed, along with the rare condition causing these symptoms and its treatment.

The attic, or epitympanum, is a crucial space located in the upper part of the middle ear, housing the heads of the malleus and the body of the incus. Because it is a largely closed-off space, its aeration depends heavily on specific, narrow pathways controlled by mucosal folds.

Attic mucosal folds form a specialized passage way for air, allowing the Eustachian tube to ventilate the mastoid and attic spaces. Blockages in these folds can lead to negative pressure and retraction pockets.

Air generally travels into the middle ear via the Eustachian tube, filling the lower cavity. For this air to reach the upper attic and mastoid air cells, it must pass through specific gaps. If these ventilation pathways—especially the anterior isthmus—become blocked by inflammation, adhesions, or thick exudate, a condition known as Selective Dysventilation Syndrome can occur.

 This section will cover the attic mucosal folds, the ventilation pathways formed by these folds, and the clinical significance of these structures.