An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 10 , ISSUE 3 ( September-December, 2018 ) > List of Articles

CASE REPORT

Simultaneous Open- and Closed-type Congenital Cholesteatomas in the Middle Ear Removed Using an Otoendoscope and Surgical Microscope

Yee-Hyuk Kim

Keywords : Cholesteatoma, Congenital, Endoscope, Middle ear

Citation Information : Kim Y. Simultaneous Open- and Closed-type Congenital Cholesteatomas in the Middle Ear Removed Using an Otoendoscope and Surgical Microscope. Int J Otorhinolaryngol Clin 2018; 10 (3):110-113.

DOI: 10.5005/jp-journals-10003-1304

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Aim: Open- and closed-type congenital cholesteatoma in the middle ear can be found at the same time and an ear endoscope can be useful to identify and remove residual cholesteatoma during surgery. Background: Congenital cholesteatoma of the middle ear usually manifests as a single growth. Open- and closed-type congenital cholesteatomas occurring simultaneously in the middle ear on one side are extremely rare. In recent years, the use of endoscopes for middle ear surgery has been gradually increasing. Case description: This report describes the case of a 6-year-old boy in whom we observed both open-type and closed-type congenital cholesteatomas in the right middle ear. The closed-type congenital cholesteatoma extended from the malleus to the posterior wall of the tympanic cavity and had destroyed the long process of the incus and crura of the stapes. An open-type congenital cholesteatoma was observed on the medial side of the malleus, supratubal recess, and attic walls. The cholesteatoma was removed successfully via a transmeatal approach using an ear endoscope and surgical microscope. Using the ear endoscope, we could identify and completely remove the residues of cholesteatoma in the epitympanum, posterior tympanum, and supratubal recess. Conclusion: It is rare for both open-type and closed-type cholesteatomas to exist simultaneously in the middle ear, as in this case. Although the cholesteatomas were more extensive than the single lesion that usually occurs, both could be removed successfully via a transmeatal approach using a surgical microscope and an ear endoscope. Clinical significance: It is important to keep in mind the possibility of simultaneous open-type and closed-type congenital cholesteatomas in the middle ear, and the use of endoscopes can reduce the extent of the surgery and help identify residual cholesteatoma.


PDF Share
  1. McGill TJ, Merchant S, Healy GB, Friedman EM. Congenital cholesteatoma of the middle ear in children: a clinical and histopathological report. Laryngoscope 1991 Jun;101(6 Pt 1):606–613.
  2. Tos M. A new pathogenesis of mesotympanic (congenital) cholesteatoma. Laryngoscope 2000 Nov;110(11):1890–1897.
  3. Bacciu A, Di Lella F, Pasanisi E, Gambardella I, Saccardi MS, Bacciu B, Vincenti V. Open vs closed type congenital cholesteatoma of the middle ear: two distinct entities or two aspects of the same phenomenon? Int J Pediatr Otorhinolaryngol 2014 Dec;78(12):2205–2209.
  4. Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F, Presutti L. Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience, Int. J. Pediatr. Otorhinolaryngol. 2015 Mar;79(3):316–322.
  5. Ayache S, Tramier B, Strunski V. Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol Neurotol. 2008 Dec;29(8):1085–1090.
  6. Soderberg KC, Dornhoffer JL. Congenital cholesteatoma of the middle ear: occurrence of an “open” lesion. Am J Otol 1998 Jan;19(1):37–41.
  7. Chang SO, Kim DW, Moon IJ, Choi BY, Lee HJ, Oh SH, Kwon SK, Lee MC, Kim CS. Postoperative results of congenital middle ear cholesteatoma according to location, type and stage. Korean J Otorhinolaryngol-Head Neck Surg 2003;46(11):922–927.
  8. Iino Y, Imamura Y, Hiraishi M, Yabe T, Suzuki J. Mastoid pneumatization in children with congenital cholesteatoma: an aspect of the formation of open-type and closed-type cholesteatoma. Laryngoscope 1998 Jul;108(7):1071–1076.
  9. Sasaki Y. Residual cholesteatoma: an experimental study in guinea pigs. Nihon Jibiinkoka Gakkai Kaiho 1995 Feb;98(2):260–266. In Japanese.
  10. Potsic WP, Samadi DS, Marsh RR, Wetmore RF, A staging system for congenital cholesteatoma. Arch Otolaryngol Head Neck Surg. 2002 Sep;128(9):1009-1012.
  11. Potsic WP, Korman SB, Samadi DS, Wetmore RF. Congenital cholesteatoma: 20 years’ experience at The Children's Hospital of Philadelphia. Otolaryngol Head Neck Surg. 2002 Apr;126(4):409-414.
  12. Takagi T, Gyo K, Hakuba N, Hyodo J, Hato N. Clinical features, presenting symptoms, and surgical results of congenital cholesteatoma based on Potsic's staging system. Acta Otolaryngol. 2014 May;134(5):462-467.
  13. Kojima, Y. Tanaka, M. Shiwa, Y. Sakurai, H. Moriyama. Congenital cholesteatoma clinical features and surgical results, Am J Otolaryngol. 2006 Sep-Oct;27(5):299–305.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.