title: Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults.
abstract: Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative 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 of 24 ± 12.2 months, and the results of a CT-scan performed 1 year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4 %) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19 ± 12.2 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 an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4 %) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1 year, and with closure of the air-bone gap by 50 %.
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France. daniele.bernardeschi@aphp.fr.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France. daniele.bernardeschi@aphp.fr.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France. daniele.bernardeschi@aphp.fr.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bernardeschi
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Francesca Yoshie
authors.initials: FY
authors.lastname: Russo
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Nguyen
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Canu
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mosnier
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Seta
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Ferrary
authors.affiliation: Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.|Sorbonne University, UPMC Univ Paris 06, 75005, Paris, France.|Inserm UMR-S 1159, Minimally Invasive Robot-based Hearing Rehabilitation, 75018, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D018424:Cholesteatoma, Middle Ear / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019468:Disease Management; D004432:Ear, Middle / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000601:surgery; D009998:Ossicular Prosthesis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery; D014433:Tympanoplasty / Q000379:methods
keywords: Atticotomy; Canal-wall-up; Cholesteatoma; Chronic otitis; Facial nerve; Mastoidectomy