A congenital tympanic membrane cholesteatoma (CTMC) in the adult: a case report

M. Casale, A. De Franco, M. Negri*, F. Piazza**, A. Incammisa, F. Salvinelli, C. Zini

Area of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University Campus Bio-Medico, Rome (Italy)

*Otorhinolaryngology Operative Unit, Ramazzini Hospital, Carpi (Italy)

**Otorhinolaryngology Operative Unit, Carlo Poma Hospital, Mantova (Italy)

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• Otorhinolaryngology

OBJECTIVE: We present an additional very rare case of a congenital tympanic membrane cholesteatoma (CTMC) in the adult.

METHOD: Case report and literature review of CTMC.

CASE REPORT: A 54-year old man was referred to us by his primary care physician who noted a white mass on the right tympanic membrane without prior history of otorrhea, tympanic perforations or previous otologic procedures. The pearl was about 5 mm diameter, centered on the umbo of a normal tympanic membrane (TM). The audiogram and the tympanogram was absolutely normal. CT confirmed a soft round shape tissue mass, located in the centre of the TM near umbo. The mass protruded both in the auditory canal and in the middle ear space, touching the malleus extremity, without any relationship with medial wall of the cavum tympani. A surgical excision was performed using a “minimal” retroauricolar transcanalar approach: the CTMC was located into the thickness of the TM, between epidermic and mucous layers. The ossicular chain was preserved intact. A partial myringoplasty (underlay technique) using a temporalis fascia graft was necessary. Histopathology confirmed a cystic cholesteatoma. After two months and one year follow-up, otoendoscopy showed a well-healed TM with a preserved normal audiogram and tympanogram.

DISCUSSION: This exceptional (probably the first reported) case showed the possible localization of the CC in the TM, also in the adult. Criteria for classification of a TM cholesteatoma as congenital and possible pathogenetic mechanisms are discussed.

Corresponding Author: Manuele Casale, MD, PhD; e-mail: m.casale@unicampus.it

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