Cholesteatoma ; diagnosis ; Ear, Middle ; Humans ; Otitis Media ; diagnosis

As tuberculous otitis media is nowadays not common, young physicians are not good at the disease. Accordingly, the correct diagnosis can be delayed causing complications, for instances, irreversible hearing loss, facial nerve paralysis, and so on. It is, moreover, so hard to make clear diagnosis when aural cholesteatoma is combined with tuberculosis of the middle ear. Recently, we experienced a case of tuberculous otitis media combined with cholesteatoma. The patient had a history of chronic otorrhea and was operated on with a presumptive diagnosis of chronic otitis media with cholesteatoma. Postoperatively the diagnosis of tuberculosis with cholesteatoma was established by histologic examination. We believe that any patient with a long history of discharging ears needs histologic examination, as tuberculosis might be the cause of infection. We report our findings in this patient and discuss the relationship between the tuberculosis and chronic otitis media with cholesteatoma with review of literatures.
Cholesteatoma* ; Cholesteatoma, Middle Ear ; Diagnosis ; Ear ; Ear, Middle ; Facial Nerve ; Hearing Loss ; Humans ; Otitis Media* ; Otitis* ; Paralysis ; Tuberculosis

Child ; Cholesteatoma, Middle Ear ; diagnosis ; pathology ; Ear, Middle ; physiopathology ; Humans ; Otitis Media with Effusion ; diagnosis ; pathology

To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage.
Cholesteatoma, Middle Ear/*complications ; Cholesteatoma, Middle Ear/diagnosis ; Cholesteatoma, Middle Ear/surgery ; *Cholesterol ; Granuloma, Foreign-Body/*complications ; Granuloma, Foreign-Body/diagnosis ; Granuloma, Foreign-Body/surgery ; Otitis Media/diagnosis ; Otitis Media/*etiology ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a keratinous mass behind an intact tympanic membrane. CMEC does not have a history of instrumentation and is less common than acquired one. Many theories have been put forward to explain the pathophysiology of CMEC, however, none of these so far have been convincingly proven. This clinical study was performed to investigate the characteristic features of CMEC and to evaluate the correlation between pathophysiology and CMEC by retrospectivly reviewing the cases. MATERIALS AND METHOD: The medical records of patients who underwent otologic procedures at the hospitals of the Catholic university from January 1993 to September 1998 have been reviewed. They were ten males and four females, ranging in age from 4 to 59 (mean age 18). RESULTS: Three of the 14 patients had the lesions isolated to the anterosuperior quadrant of the mesotympanum which were cystic, easily removed and did not affect hearing. The others had more serious condition with extension into the posterior mesotympanum, which were large, often too extensive to indicate a formative site, and causing ossicular damage. CONCLUSION: CMEC presents in two distinctive forms according to the site of formation: the anterosuperior and posterior mesotympanum. The review suggest that the pathophysiology of posterior lesions may be different from anterior ones. For early diagnosis of CMEC, screening program should be carried out in children to prevent the more extensive diseases.
Child ; Cholesteatoma, Middle Ear* ; CME-Carbodiimide ; Ear, Middle* ; Early Diagnosis ; Female ; Hearing ; Humans ; Male ; Mass Screening ; Medical Records ; Tympanic Membrane

Cholesterol granuloma in the middle ear cleft can occur in two clinical situations. It may be seen in chronic otitis media with a tympanic membrane perforation, or behind an intact tympanic membrane in a separate group. We reviewed 21 cases of cholesterol granuloma occurred in the middle ear cleft without tympanic membrane perforation. They presented as blue ear drum in most cases, but some cases were accompanied with inflammatory disorders in the middle ear such as adhesive otitis media or pars flaccida cholesteatoma. Abnormal findings of tympanic membrane of the contralateral ear were found in 8 cases. Bone destruction by cholesterol granuloma itself was found in 3 cases. This finding suggested that cholesterol granuloma led to bony lesion which was considered in the differential diagnosis of destructive lesion in the middle ear cleft. If ventilation tube insertion is inadequate preoperatively, surgical removal of pathologic lesion with good aeration of middle ear cleft is treatment of choice.
Adhesives ; Cholesteatoma ; Cholesterol* ; Diagnosis, Differential ; Ear ; Ear, Middle ; Granuloma* ; Otitis Media ; Tympanic Membrane Perforation* ; Tympanic Membrane* ; Ventilation

OBJECTIVE: Differences in clinical features, especially facial nerve canal leision between cholesteatoma in external auditory meatus and middle ear were compaired. METHOD: A retrospective clinical analysis was made. Clinical data included 125 cases of middle ear cholesteatoma with facial nerve canal leision and 28 cases of cholesteatoma occurred in external auditory canal from 2003-01-2014-08 in our hospital. RESULT: Clinical course of cholesteatoma in external auditory canal was 4.97 ± 7.51 years, course of middle ear cholesteatoma was 16.60 ± 14.42 years (P < 0.01). 21 cases (75%) of external auditory canal cholesteatoma were manifested as pneumatic mastoid and 110 cases (88%) of middle ear cholesteatoma were manifested as diploic mastoid respectively. 22 cases (78.6%) of facial nerve canal damage-in mastoid segment in cholesteatoma of external auditory meatus and 76 cases (60.8%) of facial nerve canal damage in tympanic segment in cholesteatoma of middle ear were observed (P < 0.01). The incidence rate of ossicular errosion in middle ear chol-esteatoma was significantly higher than that in external auditory meatus (P < 0.01). The incidence of semicircular canal defects in middle ear cholesteatoma (30.4%), was significantly higher when comparing to the incidence (10.7%) in cholesteatoma of external auditory meatus (P < 0.05). CONCLUSION The site of facial nerve canal lesion in middle ear cholesteatoma and cholesteatoma of external auditory meatus were different. More attention should be paid before and during operation to avoid facial nerve injury, including physical examinations, especial otologic exams, radiological reading and careful operation.
Cholesteatoma, Middle Ear ; diagnosis ; pathology ; Ear Canal ; pathology ; Ear, Middle ; pathology ; Facial Nerve Injuries ; complications ; Humans ; Incidence ; Mastoid ; pathology ; Retrospective Studies ; Semicircular Canals ; pathology

CT and MR findings of nine cases with intratemporal facial nerve nouromas were described and compared with CT findings of 3 cases with facial nerve palsy and facial nerve canal erosion which may mimic facial nerve neuroma. The tympanic segment of the facial nerve was involved in 8 cases, mastoid segment in 7 cases and labyrinthine segment in 5 cases. The lesions were easily diagnosed with high resolution CT with bone algorythms by showing the expansion of bony structures along the course of the facial nerves. In 4 cases with large vertical segment tumors. Extensive destruction of mastoid air cells and external auditory canals posed difficulty in making a diagnosis. Two out of 5 cases with labyrinthine segment imvolvement were presented as middle cranial fossa masses. MRI with enhancement was performed in 4 cases and was useful in characterizing the lesion as a tumor with its superior sensitivity to enhancement. Three cases of facial neuroma-mimicking lesion including post-inflammatory perineural thickening. Perineural extension from parotid adenoidcystic carcinoma, and congenita: cholesteatoma showed irrgular erosion or mild expansion of the facial nerve canal which may be helpful for differential diagnosis from neuromas.
Cholesteatoma ; Cranial Fossa, Middle ; Diagnosis ; Diagnosis, Differential ; Ear Canal ; Facial Nerve* ; Magnetic Resonance Imaging ; Mastoid ; Neuroma* ; Paralysis

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.
Adhesives ; Cholesteatoma ; Diagnosis ; Ear, Middle* ; Humans ; Mastoid* ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Temporal Bone* ; Tympanic Membrane

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.
Adhesives ; Cholesteatoma ; Diagnosis ; Ear, Middle* ; Humans ; Mastoid* ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Temporal Bone* ; Tympanic Membrane