Cholesteatoma behind an intact tympanic membrane in adult life: congenital or acquired?

AbstractBackground:Congenital cholesteatoma occurring behind the tympanic membrane is typically located in the anterior middle ear.Objective:To investigate the location, clinical features and treatment of cholesteatomas located behind an intact tympanic membrane in adults.Methods:Review of a series of 265 consecutive, new, adult cases of previously untreated cholesteatoma seen by the author over a 22-year period.Results:Seventeen (6 per cent) cases were located behind an intact tympanic membrane without any evidence of a retraction pocket of the attic or pars tensa. Ten (59 per cent) of these patients had undergone previous ear surgery and therefore the disease could reasonably be considered to be iatrogenic. The most common presentation was conductive deafness with no other symptoms (71 per cent). In all of the cases, the disease was located in the posterior half of the middle-ear space. The most common surgical management was simple excision of the disease via a tympanotomy. Two cases (12 per cent) developed residual disease.Conclusion:The majority of the cases in this series were likely to be acquired cholesteatomas. This type of disease often presents with conductive hearing loss alone.

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Endoscopic exploratory tympanotomy in cases of conductive hearing loss with intact tympanic membrane: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194569 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1476

Author(s):

Shankar Bettadapura Govindan ◽

Yogeshwar Chandrashekar

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Common Finding ◽

Middle Ear Anatomy ◽

Conductive Hearing ◽

Outcome Of Surgery ◽

Revision Stapedotomy ◽

Intact Tympanic Membrane

Background: Determining the cause of conductive hearing loss with an intact tympanic membrane has been a challenge for the otologists for over decades. The aim of this study is to ascertain the usefulness of endoscopes to study the various middle ear pathologies on performing endoscopic exploratory tympanotomy.Methods: A retrospective analysis of various pathologies encountered in the middle ear in 88 patients who underwent endoscopic exploratory tympanotomy done over a study period of 3.5 years (January 2015 to June 2018). Results: In our study, age of the patients ranged from 14 to 50 years with a mean age of 32 years. Most common finding on exploration was otosclerosis in 59 patients followed by revision stapedotomy in 12 patients. 5 patients had normal middle ear findings with all ossicles intact and mobile while other pathologies encountered were tympanosclerosis (4.6%), biscuit foot plate (2.3%), mucosal bands (3.4%) and middle ear developmental anomalies (3.4%).Conclusions: On exploring the middle ear knowing the various aetiologies helps in better preoperative counseling of the patients for the outcome of surgery. Endoscopic approach for exploratory tympanotomy has the benefit of excellent resolution with higher magnification and wider panoramic view of middle ear anatomy.

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Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery

Otolaryngology ◽

10.1016/s0194-5998(98)70183-4 ◽

1998 ◽

Vol 119 (1) ◽

pp. 125-130 ◽

Cited By ~ 8

Author(s):

Juha-Pekka Vasama ◽

Jyrki P. Mäkelä ◽

Hans A. Ramsay

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Pure Tone ◽

Conductive Hearing Loss ◽

Adult Patients ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Pure Tone Average ◽

The Mean ◽

Conductive Hearing

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)

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Modified sleeve tympanotomy approach for removal of congenital cholesteatoma

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003435 ◽

2008 ◽

Vol 122 (12) ◽

pp. 1365-1367 ◽

Cited By ~ 3

Author(s):

H J Park ◽

G H Park ◽

J E Shin ◽

S O Chang

Keyword(s):

Hearing Loss ◽

Case Report ◽

Tympanic Membrane ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Tympanic Cavity ◽

Operative Techniques ◽

Congenital Cholesteatoma ◽

The Right ◽

Conductive Hearing

AbstractObjective:We present a technique which we have found useful for the management of congenital cholesteatoma extensively involving the middle ear.Case report:A five-year-old boy was presented to our department for management of a white mass on the right tympanic membrane. This congenital cholesteatoma extensively occupied the tympanic cavity. It was removed through an extended tympanotomy approach using our modified sleeve technique. The conventional tympanotomy approach was extended by gently separating the tympanic annulus from its sulcus in a circular manner. The firm attachment of the tympanic membrane at the umbo was not severed, in order to avoid lateralisation of the tympanic membrane.Conclusion:Although various operative techniques can be used, our modified sleeve tympanotomy approach provides a similarly sufficient and direct visualisation of the entire middle ear, with, theoretically, no possibility of lateralisation of the tympanic membrane and subsequent conductive hearing loss.

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A bifid intra-tympanic facial nerve in association with a normal stapes

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000570 ◽

2006 ◽

Vol 120 (5) ◽

pp. 414-415 ◽

Cited By ~ 9

Author(s):

J Ahmed ◽

P Chatrath ◽

J Harcourt

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Anatomical Variations ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Ossicular Reconstruction ◽

Conductive Hearing

A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.

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Effect of Conductive Hearing Loss and Middle Ear Surgery on Binaural Hearing

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948609500516 ◽

1986 ◽

Vol 95 (5) ◽

pp. 525-530 ◽

Cited By ~ 19

Author(s):

Joseph W. Hall ◽

Eugene L. Derlacki

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Auditory Processing ◽

Conductive Hearing Loss ◽

Binaural Hearing ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Hearing Thresholds ◽

Masking Level Difference ◽

Conductive Hearing

This study investigated whether conductive hearing loss reduces normal binaural hearing advantages and whether binaural hearing advantages are normal in patients who have had hearing thresholds improved by middle ear surgery. Binaural hearing was assessed at a test frequency of 500 Hz using the masking level difference and interaural time discrimination thresholds. Results indicated that binaural hearing is often poor in conductive lesion patients and that the reduction in binaural hearing is not always consistent with a simple attenuation of the acoustic signal. Poor binaural hearing sometimes occurs even when middle ear surgery has resulted in bilaterally normal hearing thresholds. Our preliminary results are consistent with the interpretation that auditory deprivation due to conductive hearing loss may result in poor binaural auditory processing.

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