Acquired Cholesteatomas Behind Intact Tympanic Membranes of Adults: A Series of 13 Cases

Abstract

Background and Objective: Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. Materials and Methods: The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). Results: A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. Conclusions: An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.