Surgical Evaluation of Cholesteatoma Secondary to Tympanic Perforation

Hirooki, Matsui; Tsukasa, Ito; Toshinori, Kubota; Takatoshi, Furukawa; Takanari, Goto; Kazunori, Futai; Chihiro, Watanabe; Seiji Kakehata

Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan

Introduction: The tympanic membrane (TM) epidermis can invade the medial surface of the TM from the margin of its perforation, without any retraction or adhesion. This condition is referred to as cholesteatoma secondary to tympanic perforation and occurs in less than 10% of patients who present with a cholesteatoma.


Study Design: A prospective case series.
Setting: University Hospital.
Patients: Twenty patients underwent endoscopic surgery for cholesteatoma secondary to tympanic perforation in 20 ears between September 2011 and December 2016.
Interventions: We have treated this condition via endoscopic surgery and have collected data on patient characteristics and clinical observations of the secondary cholesteatoma.


Main Outcome Measures: We examined the size of the tympanic membrane perforation, staging, surgical procedure and hearing results.

The TM perforation was medium-sized or larger in 19 ears (95%). The cholesteatoma was localized in the tympanic cavity in 10 ears (50%) and involved two or more sites in 10 ears (10%) with no cholesteatoma invading the antrum or mastoid. Ossiculoplasty with intact chain preservation was performed for 14 ears (70%); ossiculoplasty with a columella on the stapes was performed for 6 ears (30%); and a residual cholesteatoma was found in 2 ears (10%). Nineteen patients were followed up for 1 year or longer and 13 of these patients had a postoperative air-bone gap of less than 20 dB.

Although cholesteatoma secondary to tympanic perforation is uncommon, it is important for the endoscopic surgeon to keep this type of cholesteatoma in mind.