Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com

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Cholesteatoma - Congenital Cases

1: A photograph of the eardrum. This eardrum is normal appearing. There is no evidence of previous perforation and there are no retraction pockets.
2: After lifting up the eardrum, frank cholesteatoma is noted within the middle ear cavity (white arrow). The black arrow is pointing towards the round window niche of the inner ear. As the cholesteatoma does not originate from the eardrum skin, it is termed a congenital cholesteatoma. This means that it was present at birth and is not a result of chronic ear problems.
3: Mastoidectomy has been performed. When approaching the interface between the mastoid cavity and the middle ear cavity, cholesteatoma is noted to be filling this area (black arrow). This cholesteatoma is lining the bone that separates the ear and mastoid from the brain, but has not eroded through this bone.
4: Another view from the mastoid cavity into the uppermost region of the middle ear cavity. The white arrow points toward the head of the incus, the second hearing bone. Cholesteatoma is clearly seen (black arrow), and is directly on top of the bony canal that holds the facial nerve. This bone overlying the facial nerve may be eroded by cholesteatoma when left untreated for a long period.
5: A view of the middle ear cavity after much of the cholesteatoma has been removed. Note cholesteatoma (black arrows) that is surrounding the stapes bone and also is present in the anterior middle ear space. In addition, the blue arrow points toward the cholesteatoma that is present on top of the facial nerve. The white arrow signifies the chorda tympani taste nerve.
6: The incus has been removed, and here we see the head of the malleus that lies just in front of the incus (black arrow). The cholesteatoma continues to be removed.
7: Cholesteatoma matrix has grown into a petrous apex air cell toward the midline of the skull (black arrow).
8: A view of the middle ear cavity after all cholesteatoma has been removed.
9: After confirmation of complete cholesteatoma removal, the hearing is reconstructed. In this patient, a titanium shoe is placed on the footplate to the inner ear and a prosthesis is used to bridge the gap between the malleus (first hearing bone) and the shoe on the footplate of the inner ear. A small cartilage graft is placed between the eardrum and the head of the prosthesis. The hearing mechanism is thus re-established.

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Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com