Introduction:

Discussion:

Exclusive endoscopic transcanal surgery is a very successful treatment for attic cholesteatoma confined to the epitympanum, as the current case series shows. At a one-year follow-up, the 45-patient group had only one recurrence, no problems, and continuous hearing improvement. These results are consistent with the increasing amount of evidence that endoscopic ear surgery (EES) for restricted cholesteatoma is beneficial. Surgeons can examine hidden recesses such the anterior epitympanic space, lateral epitympanum, and supratubal recess thanks to rigid endoscopes' improved visibility. These recesses are often missed by microscopic procedures because of their straight-line optical restrictions. ^(1-3) The remarkable clearance rates seen in endoscopic surgery are probably a result of this enhanced access. By showing that angled endoscopes permitted full view of Prussak's space and the epitympanum without the requirement for mastoidectomy, Tarabichi's seminal work first demonstrated the viability of endoscopic removal of attic cholesteatoma.⁽⁴⁾ Marchioni and associates built on these discoveries by providing thorough endoscopic mapping of the epitympanum and stressing the significance of examining the anterior attic and supratubal recess, regions that are frequently in charge of residual disease when treated with conventional microscopy. ^(5-7)

The study's hearing results were good, with postoperative ABG closure to 5–10 dB. Similar gains have been documented in a number of EES series, where improved disease clearance and middle ear structural preservation lead to improved functional results.^(8,11,12) The endoscopic technique allowed for the atraumatic dissection of matrix and ossicular chain, allowing for the best repair when necessary, despite the fact that all patients showed incus erosion and one-third had malleus head erosion. Strong postoperative audiometric outcomes were probably also influenced by the preservation of the stapes superstructure in all instances. The minimally intrusive nature of the endoscopic approach is one of its key advantages. No patient in this series needed postauricular access or canaloplasty. This is in line with research by Ayache and others that support the transcanal endoscopic technique as a tissue-sparing substitute that improves cosmetic results and lowers postoperative morbidity.^(9,13) The safety profile of EES for limited attic disease is further supported by the lack of sequelae such tympanic membrane reperforation, facial nerve damage, and postoperative infection. Compared to microscopic surgery, endoscopic cholesteatoma surgery often has similar or lower recurrence rates. In a systematic review, Hunter et al. shown that endoscopic methods lessen residual disease by enabling examination of previously unreachable areas. ⁽¹⁰⁾ In a similar vein, Kuo and Shiao highlighted the importance of EES in spotting tiny residual pearls that could otherwise go unnoticed. ⁽¹⁴⁾  This series' primary drawback is its one-year follow-up. Longer-term observation, preferably with diffusion-weighted MRI, is recommended since cholesteatoma recurrence may appear later. A comparison microscopic arm, which would confirm the endoscopic method's superiority, is also absent from the study. However, with 45 consecutive patients and consistent surgical technique, the results provide compelling evidence that endoscopic transcanal surgery is the best treatment option for confined attic cholesteatoma.

Our results support the safety, efficacy, and low invasiveness of exclusive endoscopic transcanal treatment of attic cholesteatoma limited to the epitympanum. Excellent visibility is made possible, total disease removal is made easier, middle ear structures are preserved, and dependable hearing results with minimal morbidity and recurrence are produced. EES is the best approach for early attic cholesteatoma when used on carefully chosen patients.

Conclusion:

Exclusive endoscopic transcanal surgery is an excellent treatment option for attic cholesteatoma limited to the epitympanum. It provides minimal morbidity, wide vision, low recurrence, and satisfactory hearing outcomes. For some patients, it might be the suggested first course of action.

Compliance with Ethical Standards:

The procedure performed in this case report was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Funding:

This study is not funded by any resources.

Conflict of Interest:

The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.

Ethical Approval:

The study was published with written consent of the patient.

Compliance with Ethical Standards:

The procedure performed in this case report was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Funding:

This study is not funded by any resources.

Conflict of Interest:

The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.

Ethical Approval:

The study was published with written consent of the patient.