LETTER TO THE EDITOR Reply to comments on: Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma? Sampath Chandra Prasad 1 • Mario Sanna 1 Received: 21 March 2016 / Accepted: 21 March 2016 Ó Springer-Verlag Berlin Heidelberg 2016 Dear Sir, In reply to the observations made by the Alicandri- Ciufelli et al., we would like to highlight the following issues. 1. We agree that we have not specified how many patients we followed up by calling up the patients. Upon revision of charts we found that only six patients were contacted telephonically. All these patients were followed up by the referring otologist and hence the description of the latest clinical examination enabled us to find out the status of hearing and recurrence. In all these cases, we asked the patient to post us copies of the reports which were subsequently analyzed. 2. The authors also point out that out of 362 patients, 59 were lost for follow-up and these were not included in the series. The referral nature of our center ensures that we have patients from all over Europe, North Africa and the Middle East. Hence, it is but natural that we lose many of such patients for follow-up. However, considering that we have had a 5-year follow-up in 258 patients, one of the largest series of patients in world literature, it is unlikely that the data would change even if the patients lost for follow-up were to be included. We maintain that there is no room for selection bias in the present series as consecutive patients were analyzed using the inclusion and exclu- sion criteria described in literature. Having published over 300 articles in peer-reviewed journals in its specialty, this center is responsible in its research and does not believe in crafting a patient bias to suit its management ideology. 3. In their next observation, the authors point out that limited epitympanic cholesteatomas operated using a microscope as described in our series were compared to more extensive cholesteatomas removed endoscop- ically. We agree to this and we were aware of this deviation. However, this handicap is due to the unstandardized method of publication of results by the authors employing the endoscope. The same argument can be made about the results published by the authors using the endoscope; that the results obtained vary in extent of surgery and pathology and hence the long-term results have not yet demonstrated to be beneficial over traditional microscopic proce- dures that have proven to yield excellent results. Our description of limited epitympanic cholesteatoma as defined in the inclusion criteria is cholesteatoma limited to the epitympanum in normal or good hearing ear (preoperative air bone gap B25 dB) with a tympano-ossicular system and mesotympanum free of disease. In this we have achieved excellent long-term results as shown in our series, in terms of preservation of hearing and total disease clearance. Since this type of pathology was the first to be approached endoscop- ically, we decided to put to test, the long-term results of endoscopic versus microscopic approaches. The otological fraternity would in fact like to see proof of benefit of the endoscopic approaches for limited epitympanic cholesteatomas in terms of hearing preservation and long-term disease clearance, before This reply refers to the article available at doi:10.1007/s00405-016- 3952-2. & Sampath Chandra Prasad sampathcp@yahoo.co.in 1 Department of Otology and Skull Base Surgery, Gruppo Otologico, C/o Casa di Cura Piacenza Privata Spa, Via Emmanueli, 42, Piacenza, 29121 Rome, Italy 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-016-4008-3