Learning Objectives:

Objectives/Hypothesis: Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study was to evaluate the anatomical and the functional results of transcanal atticotomy (TA) in this pathological situation.

Study design: Retrospective medical record review.

Methods: Records of 27 adult patients treated from 2008 to 2014 who underwent TA for primary cholesteatoma surgery were reviewed. Preoperatively, physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow up (FU) of 24 ± 12.2 months and the results of CT-scan imaging performed 1 year after surgery to evaluate the presence of residual disease.

Results: Surgeries were uneventful. During the FU, 1 patient (4%) experienced retraction of the attical reconstruction, all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bon- gap was 19 ± 12.2 dB and 10 ± 7.3 dB pre-operatively and post-operatively, respectively (mean ± SD, p = 0.001, paired t-test). Twenty-two patients (81%) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15%) presenting opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4%) had displacement of the ossicular prosthesis.

Conclusion: Cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no residual visible at 1 year and closure of ABG by 50%.