Intratympanic Membrane Congenital

Cholesteatoma
July 20, 2015 by Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD

Cholesteatoma should be differentiated from other conditions with similar

otoscopic findings, such as myringosclerosis.
A 1-year-old girl was referred for evaluation of a white mass on her right
tympanic membrane. She had no history of otitis media, ear trauma, or otologic
surgery. Otoscopic examination revealed a white mass on the posterosuperior
quadrant of the right tympanic membrane but was otherwise normal (figure 1).
Conditioned orientation reflex audiometry showed normal hearing thresholds
bilaterally. Computed tomography (CT) showed a round soft-tissue mass measuring
2.5 mm in diameter, located in the right tympanic membrane, with minimal protrusion
into the tympanic cavity (figure 2). The patient was diagnosed with an intratympanic
membrane congenital cholesteatoma.
The patient underwent surgery through an endaural approach. The overlying
squamous epithelial layer of the tympanic membrane was circumferentially dissected
along the edge of the cholesteatoma. The cholesteatoma was enucleated, leaving a
small perforation in the mucosal layer, which was covered with a piece of chitin sheet.
Histologic examination of the specimen confirmed the diagnosis of cholesteatoma. At
follow-up 1 year later, there was no perforation of the tympanic membrane or
recurrence of the cholesteatoma.
Intratympanic membrane congenital cholesteatoma is rare, with only 30
previously reported cases.1-4 This condition is usually asymptomatic and is usually
discovered incidentally during childhood.1-3The typical appearance is a round, white
mass on the tympanic membrane.1-4
Cholesteatoma should be differentiated from other conditions with similar
otoscopic findings, such as myringosclerosis, in which calcified plaques typically
develop after procedures such as myringotomy or placement of a ventilation
tube.5 Calcified plaques in the lamina propria appear as thin plates, whereas
cholesteatoma has a sphere-like shape. CT is useful for evaluating the shape of a mass

within the tympanic membrane, and the degree of protrusion into the tympanic
cavity.1,3
The endaural approach offers a sufficient surgical field for removal of a small
cholesteatoma, and enucleation of the cholesteatoma with preservation of the mucosal
layer is minimally invasive.1-4 If the tympanic membrane is perforated, it can be
repaired by myringoplasty2 or by covering the perforation with wound-healing
materials.

Figure 1. Otoscopic view of the right ear shows the round, white
mass on the tympanic membrane.

Figure 2. Axial CT image of the right temporal bone demonstrates

the round mass within the right tympanic membrane (arrow). There
is no protrusion of the mass into the tympanic cavity.

References
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Reddy CE, Goodyear P, Ghosh S, Lesser T. Intratympanic membrane cholesteatoma: A rare

incidental finding. Eur Arch Otorhinolaryngol 2006; 263 (263): 1061-4.
Grindle CR, Shah G, O'Reilly RC. Intratympanic membrane cholesteatoma: A rare bilateral
presentation within a single-institution case series. Int J Pediatr Otorhinolaryngol 2011; 6 (6): 373-5.
Yoshida T, Sone M, Mizuno T, Nakashima T. Intratympanic membrane congenital
cholesteatoma. Int J Pediatr Otorhinolaryngol 2009; 73 (73): 1003-5.
Lee BD, Park MK. Congenital cholesteatoma of the tympanic membrane. Ear Nose Throat J
2011; 90 (12): E36-7.
Yaman H, Guclu E, Yilmaz S, Ozturk O. Myringosclerosis after tympanostomy tube insertion:
Relation with tube retention time and gender. Auris Nasus Larynx 2010; 37 (37): 676-9.