Clinical Findings of Cholesteatoma Behind an Intact Tympanic Membrane in Adults.

Abstract

The aim of this study was to describe the clinical features and surgical results in a series of adult intact tympanic membrane cholesteatoma (ITMC). The author retrospectively analyzed 17 adult patients diagnosed with ITMC who underwent surgery. The author investigated the demographic data, presenting symptoms, endoscopic findings, disease location, surgical technique, post-operative complications, and outcomes. Diagnosis was made based on a white mass behind an intact tympanic membrane in 14 cases and on explorative surgery and CT in the remaining 3 patients. ITMC presented as a cystic lesion with a complete capsule. ITMCs were removed through an endoscopic endaural approach combined with cartilage myringoplasty in 14 cases and intact canal wall mastoidectomy was performed in 3 cases. No recurrent cholesteatoma or iatrogenic sensorineural hearing loss was observed during the follow-up period. The mean ABG was 17.7 ± 2.7 dB perioperatively and 10.2 ± 1.3 dB postoperatively. Intact tympanic membrane cholesteatoma in adults may have both congenital and acquired origins, but it is not possible to differentiate between a slow growing acquired or indolent congenital cholesteatoma. ITMC typically presents as a cystic lesion with a complete capsule that can be treated successfully via an endoscopic tympanotomy approach, but in a minority of cases a more extensive mastoidectomy may be required.