Learning Objectives: As the endoscopic exam of tympanic membrane in young children become more popular, detection rate of early stage of congenital cholesteatoma has been increased significantly. Once identified, every cholesteatoma should be treated surgically with a primary goal of total eradication to obtain a safe and dry ear. The congenital cholesteatoma at anterior superior quadrant can be removed relatively easier than the posterior located one. Posterior mesotympanic choelsteatoma spreads posterior-superiorly, medial to incus body. It invades into the facial recess and sinus tympani and is prone to involve stapes and its joint. Epitympanum and mastoid invasion should be accessed by temporal bone CT and diffusion MRI image technique. These preoperative diagnostic evaluation can prevent the unnecessary mastoidectomy. Nowadays, it has been more popular to use endoscope during ear surgery. By using endoscopic assistance, transcanal approach could be enough to manage the most of congenital cholesteatoma which does not extend to the mastoid. In addition to that, the use of endoscope is justified for direct visualization of the deep sinus tympani. A long term follow up is necessary in order to detect the residual or recurrent cholesteatoma. Unwanted retraction or adhesion of tympanum are not infrequent especially in the posterior mesotympanic cholesteatoma cases. Our experience and management algorithm will be discussed.
As the endoscopic exam of tympanic membrane in young children become more popular, detection rate of early stage of congenital cholesteatoma has been increased significantly. Once identified, every cholesteatoma should be treated surgically with a primary goal of total eradication to obtain a safe and dry ear. The congenital cholesteatoma at anterior superior quadrant can be removed relatively easier than the posterior located one.
Posterior mesotympanic choelsteatoma spreads posterior-superiorly, medial to incus body. It invades into the facial recess and sinus tympani and is prone to involve stapes and its joint. Epitympanum and mastoid invasion should be accessed by temporal bone CT and diffusion MRI image technique. These preoperative diagnostic evaluation can prevent the unnecessary mastoidectomy.
Nowadays, it has been more popular to use endoscope during ear surgery. By using endoscopic assistance, transcanal approach could be enough to manage the most of congenital cholesteatoma which does not extend to the mastoid. In addition to that, the use of endoscope is justified for direct visualization of the deep sinus tympani.
A long term follow up is necessary in order to detect the residual or recurrent cholesteatoma. Unwanted retraction or adhesion of tympanum are not infrequent especially in the posterior mesotympanic cholesteatoma cases. Our experience and management algorithm will be discussed.
