A Tympanic Membrane Cholesteatoma: A Case Report and Literature Review

A 45-year-old female complained of right hearing loss with fullness in recent months. She underwent right tympanoplasty type I about 4 years ago. On physical and otoscopic examination, a pearl-like mass about 3 x 4 mm in size over central part of right ear drum was noted. Pure tone audiometry test showed 35 decibel (dB) average hearing loss of right ear, and 20 dB of left ear. Tympanogram test showed bilateral type A. Computed tomography with thin cuts of the temporal bone revealed a 3 x 4 mm soft tissue mass over central part of right ear drum. Excision of the mass under microscope was smoothly done. A cholesteatoma was confirmed by pathology. She was uneventful during a regular follow-up. Cholesteatomas are benign collections of keratinized squamous epithelium within the middle ear. A cholesteatoma usually occurred in middle ear cavity or mastoid region, sometimes in external auditory canal. Tympanic membrane cholesteatomas were seldom reported.

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A Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2018.v26i1.155 ◽

2018 ◽

Vol 26 (1) ◽

pp. 43-47

Author(s):

Santosh U P ◽

Sridurga J ◽

Aravind D R

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Operative Findings

Introduction Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively. In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected. Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.

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Cholesteatoma Medial to an Intact Tympanic Membrane in 34 Young Children

PEDIATRICS ◽

10.1542/peds.74.2.236 ◽

1984 ◽

Vol 74 (2) ◽

pp. 236-240

Author(s):

Richard H. Schwartz ◽

Kenneth M. Grundfast ◽

Bruce Feldman ◽

Richard E. Linde ◽

Karen L. Hermansen

Keyword(s):

Hearing Loss ◽

Young Children ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Early Stage ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Simple Excision ◽

Otoscopic Examination

Thirty-five cholesteatomas medial to intact eardrums were treated in 34 children between 1976 and 1982. Six (18%) children had never had a documented episode of otitis media. Seventeen (50%) children, in whom the lesion was diagnosed at an early stage, underwent simple excision of the cholesteatoma without the need for extensive middle ear surgery. Findings from postoperative audiograms were normal for all such children. Cholesteatoma has recurred in eight (23%) children to date. Most recurrences were diagnosed 15 months or less after surgery. Routine careful otoscopic examination is essential in order to discover cholesteatoma at an early stage and to avoid hearing loss and the need for extensive otomastoid surgery. In order to perform an accurate examination of the eardrum, a halogen-illuminated otoscope and pneumo-otoscopy should be used by the pediatrician routinely. Particular attention should be paid to the posterior-superior quadrant of the tympanic membrance where a cholesteatoma is usually located.

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Otosurgery of incipient adhesive otitis media in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215100146705 ◽

1984 ◽

Vol 98 (4) ◽

pp. 341-345 ◽

Cited By ~ 5

Author(s):

Kristian Otto Nielsen ◽

Kristian Bak-Pedersen

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Present Method ◽

Evaluation Criteria ◽

Therapeutic Results ◽

Adhesive Otitis Media

SummaryIn 20 children, 21 ears with incipient adhesive otitis media were treated by mobilizing the thin, adherent tympanic membrane, strengthening it with a fascial graft, inserting SilasticR on the promontory, and establishing middle-ear drainage. The evaluation criteria were adhesive, atrophic and retractive changes in the tympanic membrane. The median follow-up period was 19 months. At follow-up, the material showed a statistically significant improvement in hearing, with a median hearing-loss of 17 db. postoperatively against 30 db. pre-operatively. There was a pronounced improvement in the adhesive and atrophic, as well as in the retractive, changes in the tympanic membrane.The present method of otosurgery is taken to be justified by the threat that incipient adhesive otitis media will develop into total middle-ear atelectasis with maximum hearing-loss and a risk of cholesteatoma. A further justification is afforded by the favourable therapeutic results.

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Isolated Incudostapedial Cholesteatomas: Unique Radiologic and Surgical Features

Ear Nose & Throat Journal ◽

10.1177/0145561320973785 ◽

2020 ◽

pp. 014556132097378

Author(s):

Bridget MacDonald ◽

Krishna Bommakanti ◽

Moises Mallo ◽

Daniela Carvalho

Keyword(s):

Hearing Loss ◽

Soft Tissue ◽

Ct Scan ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Soft Tissue Mass ◽

Ossicular Chain ◽

Ct Scans ◽

Tissue Mass ◽

Conductive Hearing

Objectives: Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery, otorrhea, or tympanic membrane perforation. They are diagnosed by a pearl-like lesion on otoscopy and computed tomography (CT) scan showing an expansile soft-tissue mass. We describe a series of patients with no prior otologic history presenting with progressive unilateral conductive hearing loss and normal otoscopy. The CT scans showed ossicular erosion without obvious soft-tissue mass. Surgery confirmed incudostapedial erosion found to be cholesteatoma. In this study, we characterize the clinical course of patients diagnosed with isolated incudostapedial cholesteatoma (IIC) and review possible pathologic mechanisms. Methods: Retrospective review of IIC cases treated by the Department of Pediatric Otolaryngology, Rady Children’s Hospital, San Diego, 2014 to 2020. Data included patient demographics, clinical features, imaging, surgical findings, and audiologic data. Results: Five patients were diagnosed with IIC (3 [60%] female; mean age at presentation 10.7 years [range 5.5-16.0]). All patients presented with postlingual unilateral conductive hearing loss and normal otoscopy without any past otologic history; delay in diagnosis ranged from 4 months to several years. The CT scans showed ossicular chain erosion with an absent long process of the incus and/or stapes superstructure. All patients underwent middle ear exploration, revealing a thin layer of cholesteatoma in the incudostapedial region, confirmed by histopathology. Mean preoperative speech reception threshold was 55 dB and improved to a mean of 31 dB in the 4 patients who underwent ossicular chain reconstruction. Conclusion: Isolated incudostapedial cholesteatoma should be included as a possible etiology in pediatric patients with insidious onset of unilateral conductive hearing loss with normal otoscopy, unremarkable otologic history, and a CT scan showing ossicular abnormality/disruption without notable middle ear mass. These patients should be counseled preoperatively regarding the possibility of cholesteatoma and should undergo middle ear exploration with possible ossiculoplasty.

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Middle-ear involvement in type I Gaucher's disease – a unique case

The Journal of Laryngology & Otology ◽

10.1017/s0022215113002521 ◽

2013 ◽

Vol 127 (12) ◽

pp. 1226-1229 ◽

Cited By ~ 2

Author(s):

A Khan ◽

P Stimpson ◽

A Karmolinski ◽

N Patel

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Disease Process ◽

Pure Tone Audiometry ◽

Type I ◽

Lysosomal Storage ◽

Management Options ◽

Gaucher's Disease ◽

Unique Case ◽

Gaucher’S Disease

AbstractObjective:Gaucher's disease is a rare autosomal recessive lysosomal storage disease. We describe a unique case of middle-ear involvement presenting with hearing loss.Case report:A five-year-old boy with known Gaucher's disease presented with bilateral hearing impairment and conductive hearing loss on pure tone audiometry with flat tympanometry traces.Intervention:Exploratory Tympanomastoidectomy revealed inflammatory material filling the mastoid and the middle ear. Histological analysis confirmed Gaucher cell infiltrates.Conclusion:This is the first detailed report in the english language literature of Gaucher's disease affecting the middle ear and the mastoid. We discuss the disease process and suggest future management options.

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Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174328 ◽

2017 ◽

Vol 3 (4) ◽

pp. 1036

Author(s):

Nabeel Malick ◽

Raveendra P. Gadag ◽

Vidyashree K. M. ◽

Shruthi Puthukulangara

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Randomised Control Trial ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Impedance Curve

Background: Chronic suppurative otitis media is a widespread disease with a significant cause of morbidity with a greater burden in the poor communities of the developing countries for which tympanoplasty is frequently undertaken. Gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. This provides the added advantage of facilitating middle ear ventilation through the Eustachian tube. The objectives of the study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gelfoam in the middle ear and without gelfoam in the middle ear and to compare and assess results for complicationsMethods: This was a randomised control trial done for a period of one year conducted in the department of otorhinolaryngology and head and neck surgery, Karnataka Institute of Medical Sciences, Hubballi which is a tertiary referral hospital. 30 patients underwent type 1 tympanoplasty without gelfoam in the middle ear and 31 patients underwent type 1 tympanoplasty with gelfoam in the middle ear. Post-operative follow up was done to look for graft uptake, hearing assessment by pure tone audiometry and impedance audiometry was done 90 days post-operatively. Results: Graft uptake was 80% in type 1 tympanoplasty without gelfoam in the middle ear and 80.6% with gelfoam in the middle ear. Both types of surgeries had significant hearing improvement, and complications like retraction and residual perforation were also comparable. Ad type of impedance curve is most common post operatively.Conclusions: Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients.

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Three-year audiological outcomes of the latest generation middle ear transducer (MET) implant

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06031-6 ◽

2020 ◽

Vol 277 (11) ◽

pp. 3013-3019

Author(s):

Henryk Skarżyński ◽

Beata Dziendziel ◽

Elżbieta Włodarczyk ◽

Piotr H. Skarżyński

Keyword(s):

Hearing Loss ◽

Word Recognition ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Mixed Hearing Loss ◽

Speech Reception ◽

Speech Reception Thresholds ◽

Technical Complication ◽

Bilateral Sensorineural Hearing Loss

Abstract Purpose To evaluate the long-term audiological outcomes and safety of the latest generation of middle ear transducer (MET) among a group of Polish patients. Methods Ten patients aged 48–72 years with bilateral sensorineural hearing loss (n = 8) and mixed hearing loss (n = 2) were included in this study. Pure tone audiometry, sound thresholds, word recognition scores in quiet and speech reception thresholds in noise were assessed. Medical and technical complication information was gathered. Results All the patients underwent unilateral implantation with the latest generation Cochlear MET between 2014 and 2016. Mean length of follow-up was 3.7 years. Compared to the unaided condition, the implant provided significant functional gain (mean M = 26.1 dB) at 12 months follow-up. Compared to before surgery, average word recognition in quiet at 65 dB and at 80 dB SPL, as well as speech reception threshold in noise, were significantly better at 12 months. However, postoperative air conduction thresholds 6 months after implantation worsened by 10.3 dB (standard deviation SD = 5.8 dB). Postoperatively, three patients had skin problems around the processor, and one of them completely resigned from using the device 5 months after activation. Technical failures occurred in 4 cases. There were 9 out of 10 patients who still used the MET, but only 5 of them used the processor regularly (every day). Conclusion Despite changes in the transducer implemented by the manufacturer, we observed a significant number of adverse events in users of the latest generation of MET.

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Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131123 ◽

1995 ◽

Vol 109 (8) ◽

pp. 710-712 ◽

Cited By ~ 7

Author(s):

T. R. Kapur

Keyword(s):

Tympanic Membrane ◽

Eustachian Tube ◽

Middle Ear ◽

Squamous Epithelium ◽

Combined Approach ◽

Tube Obstruction ◽

Incomplete Removal ◽

Tube Dysfunction ◽

Cause Of Failure ◽

Causes Of Failure

AbstractForty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.

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Unchanged unilateral hearing loss and ipsilateral growth of an acoustic neuroma from 1 to 4 cm

The Journal of Laryngology & Otology ◽

10.1017/s0022215100122704 ◽

1993 ◽

Vol 107 (3) ◽

pp. 230-232

Author(s):

Jos P. P. M. van Leeuwen ◽

Cor W. R. J. Cremers ◽

Henk O. M. Thijssen ◽

Henk E. Meyer

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

False Negative ◽

Pure Tone Audiometry ◽

Tumour Volume ◽

Sensorineural Hearing ◽

Speech Audiometry ◽

Volume Doubling Time ◽

Volume Doubling

Progressive sensorineural hearing loss is the most important early symptom of a cerebellopontine angle process. A case report is presented of a 42-year-old woman who was referred to our department in 1979. Oil cistemography showed non filling of the left internal acoustic canal. Audiometry was planned as the method of control, but she did not return until nine- years later. In 1988, an acoustic neurionoma of 4 cm diameter was found in the left CPA. Pure tone audiometry and speech audiometry showed that during the nine-year interval, her 60 dB flat sensorineural hearing loss and speech perception thresholds had remained almost unchanged. A follow-up with only tone and speech audiometry can lead to a false negative diagnosis in some of these cases. Calculation of the growth in tumour volume over nine years in this patient showed a tumour volume doubling time of about 15 months.

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