In response to letter to the editor entitled ‘is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

In this previous study, we compared exclusive endoscopic ear surgery (EES) withmicroscopic earsurgery (MES) in the surgical treatment of a series of‘attic’cholesteatomas.Clarifications in response to some observations made by Zhengcai-Lou et al. are reported below. In the study conclusions, the authors did not indicate the EES as theoptimal treatment in cases of‘attic’ cholesteatoma. Through the study results, they showed how in cases of epitympanic cholesteatomas, both approaches are possible with similar results in terms of: surgical outcomes, postoperative complications, average postoperative air-bone conduction thresholdsand tympanic graft success rates. The better results obtained regarding postoperative pain and healing times with EES play a limited role in order to prefer this surgical approach.