Patency of Anterior Epitympanic Space and Surgical Outcomes After Endoscopic Ear Surgery for the Attic Cholesteatoma.

OBJECTIVE To reveal the patency of the anterior epitympanic space (AES) and the surgical outcomes after transcanal endoscopic ear surgery (TEES) for attic cholesteatoma with a classification of anatomical variation of the AES. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Seventy-four ears (72 patients with early-stage (I or II) attic cholesteatoma) aged between 16 and 85 years (mean: 48.9 yr) who underwent TEES between 2015 and 2017 were analyzed. INTERVENTION Tympanoplasty with atticoantrotomy was performed with TEES. TEES was performed using a rigid endoscope with an outer diameter of 2.7 mm. MAIN OUTCOME MEASURE The tensor fold in the AES anatomical classification, the postoperative patency of the AES evaluated by computer tomography images, and hearing outcomes based on the American Academy of Otolaryngology and Head and Neck Surgery criteria were evaluated after TEES for early-stage attic cholesteatoma. RESULTS There were 14 (18.9%) ears with a vertical tensor fold orientation, 29 (39.2%) ears with an oblique orientation, and 29 (39.2%) ears with a horizontal orientation. The total postoperative patency rate in the AES was 81.0%, without any significant difference in the anatomical variation in the AES, whereas the rate of preoperative complete tensor fold was 90.5%. Cholesteatoma recurrence was observed in three cases (4.1%), and all recurrent cases had obstructed AES. No significant difference was found in the postoperative air-bone gap regardless of the patency of the AES. CONCLUSION Our findings indicate that TEES is useful in restoring ventilation in the AES, resulting in favorable management of cholesteatoma.