External ear canal cholesteatoma

August 31, 2010     Murat Topdag, MD and Efser Can, MD

Therapeutic approaches to complicated cholesteatoma of the external auditory canal: A case of associated facial paresis

July 31, 2010     Malek Belcadhi, MD, Houda Chahed, PhD, Radhouane Mani, MD, and Kamel Bouzouita, MD


Spontaneous cholesteatoma of the external auditory canal (EAC) is an uncommon condition that is difficult to diagnose. In a patient with such a possibility, serious clinical investigation along with radiologic and histologic exploration should be performed early on because a delay in treatment can lead to severe complications. Given the rarity of EAC cholesteatoma, no therapeutic consensus has emerged. The type of management depends on the extensiveness of invasion and bone erosion and the status of the neighboring structures. The primary therapeutic objectives are to eradicate the cholesteatoma and then to fill in the residual cavity, which in our opinion can be best accomplished with a muscle flap and EAC reconstruction. Postoperative follow-up should be carried out to look for infections, stenosis, and recurrence. We report a new case of spontaneous EAC cholesteatoma, and we review its diagnostic and therapeutic challenges.

Congenital cholesteatoma in the tympanic membrane

July 31, 2010     Min-Tsan Shu, MD, Hung-Ching Lin, MD, Cheng-Chien Yang, MD, and Yu-Chun Chen, MD

Cholesterol granuloma and recurrent cholesteatoma after canal-wall-down mastoidectomy

June 30, 2010     S. Todd Hamilton, MD, Swarupa A. Gadre, MD, and Arun K. Gadre, MD, FACS

A large postauricular cutaneous mastoid fistula caused by a cholesteatoma

March 31, 2010     Raman Wadhera, MS, S.P. Gulati, MS, Vijay Kalra, MS, Anju Ghai, MD, and Ajay Garg, MS

Diffusion-weighted imaging for cholesteatoma evaluation

March 31, 2010     Kara M. Schwartz, MD, John I. Lane, MD, Brian A. Neff, MD, Bradley D. Bolster Jr., PhD, Colin L. Driscoll, MD, and Charles W. Beatty, MD


Computed tomography (CT) has long been considered the optimal imaging technique for the detection of cholesteatomas. However, this modality often lacks specificity, particularly in patients with an absence of definite bony erosion or a history of surgical excision. Several investigators have proposed magnetic resonance imaging with diffusion-weighted imaging (DWI) as a means of diagnosing the presence and extent of cholesteatomas, particularly when CT results are equivocal. The rationale for the use of DWI is that cholesteatomas demonstrate restricted diffusion and granulation tissue does not. In this retrospective study, we review our experience with 12 patients who had undergone DWI for evaluation of a mass in the middle ear, mastoid, or petrous apex. Ten of these patients had previously undergone middle ear surgery, 8 for cholesteatoma resection. On DWI, 9 patients demonstrated restricted diffusion. Of these, 8 patients underwent surgical resection, and all were found to have had a cholesteatoma. Of the 3 patients who had not demonstrated restricted diffusion on DWI, 2 did not undergo surgery and the other was found to have only chronic inflammation at surgery. Based on our limited experience, we believe that DWI can be useful in confirming the diagnosis of cholesteatoma. Moreover, it may alter patient management, particularly in patients whose previous tympanoplasty/mastoidectomy does not allow for an adequate clinical inspection of the middle ear cavity.

Dissection of the incus long process by the chorda tympani nerve

March 31, 2010     Julia Vent, MD, PhD and Dirk Beutner, MD


October 31, 2009     Gabriel Caponetti, MD, Lester D. R. Thompson, MD, and Liron Pantanowitz, MD

External auditory canal cholesteatoma: A rare complication of tympanoplasty

October 31, 2009     Borlingegowda Viswanatha, MS, DLO


The author describes a rare case of external auditory canal cholesteatoma. This particular case occurred in a 20-year-old woman who had undergone a tympanoplasty 1 year earlier. Previous tympanoplasty is one of several known predisposing factors for external auditory canal cholesteatoma. The mass was excised, and it was diagnosed on histopathology. The patient recovered uneventfully.

An estimate of the number of mastoidectomy procedures performed annually in the United States

April 30, 2008     Lesley C. French, MD, Mary S. Dietrich, PhD, and Robert F. Labadie, MD, PhD


We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10,000 population in Maryland and 2.55 to 2.74/10,000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10,000 population. Based on these data, we estimate that between 30,000 and 60,000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.

Fibrous dysplasia of the temporal bone complicated by cholesteatoma and thrombophlebitis of the transverse and sigmoid sinuses: A case report

February 1, 2008     Rodrigo Martinez, MD and Jay B. Farrior, MD


Fibrous dysplasia is a benign condition that can affect the skull and facial bones and cause a broad spectrum of otolaryngologic conditions. We present the case of a boy with polyostotic fibrous dysplasia with involvement of the temporal bone that was first diagnosed when he was 9 years old. His condition eventually became complicated by cholesteatoma and thrombophlebitis of the left transverse and sigmoid sinuses, and he died of his disease at the age of 19 years. We discuss these and other complications of fibrous dysplasia of the temporal bone and their management.

Congenital middle ear cholesteatoma

October 31, 2007     J. Walter Kutz Jr., MD and Rick A. Friedman, MD
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