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This study aims to test the effectiveness and safety of exteriorization surgery comprising atticotomy and obliteration of the additus ad antrum, also referred to as attic exposition–antrum exclusion (AE-AE) surgery. This surgery combines otoendoscopy with surgical microscopy for the treatment of acquired pars flaccida cholesteatoma in stages Ib and II (according to the classification of the Japan Otological Society) present in the attic and the tympanic cavity. We reviewed a historical cohort of 65 patients. Of the total, 21 were treated with canal wall-up tympanomastoidectomy (CWU). Patients in whom the AE-AE technique was performed had residual and recurrence rates of 0% and 9.1%, respectively, compared with 28.6% and 9.5%, respectively, for those treated with CWU. In the AE-AE procedure, surgery is performed in one stage compared with the two stages in CWU, to address the risk of residual cholesteatoma. Auditory thresholds were higher in the CWU group compared with the AE-AE group in the pre-surgery (53 ± 16 vs. 44 ± 15 dB; p = 0.039) and post-surgery (52 ± 18 vs. 42 ± 16 dB; p = 0.042) evaluations but not in pre–post-surgery comparisons for either the AE-AE technique (p = 0.89) or the CWU technique (p = 0.96). We conclude that AE-AE is an effective and safe technique for the treatment of acquired stage Ib and II cholesteatoma present in the attic and tympanic cavities.

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The aim of this study is to test the effectiveness and safety of AE-AE surgery combining otoendoscopy and surgical microscopy in the treatment of acquired pars flaccida cholesteatoma in stages Ib and II of the Japan Otological Society classification occupying the tympanic cavity and attic. A historical cohort study on 65 patients. Of the total, 44 patients were treated by AE-AE surgery using an otoendoscope and 21 with canal wall-up tympanomastoidectomy (CWUT). Patients in whom the AE-AE technique was performed had a lower recurrence rate (9%) compared to those treated with CWUT (38%); p=0.013. In addition, the median time to recurrence was lower in the AE-AE group (4 years [P25-75= 1.25-2-75]) than in CWUT group (2 years [P25-75= 3.25-4.75]); p=0.048. Thresholds were higher in the CWUT group compared to the AE-AE group in pre-surgery (53±16 vs 44±15; p=0.039) and post-surgery (52±18 vs 42±16 dB dB; p=0.042), but not in pre-post-surgery comparisons neither in the AE-AE technique (p= 0.89) nor in the CWUT technique (p= 0.96). We concluded that AE with otoendoscopic support is an effective and safe technique for acquired cholesteatomas occupying box and attic in stages IB and II.