Lou Zhengcai
Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, Zhejiang Province, China.
J Craniofac Surg. 2021 Jun 1;32(4):e332-e334. doi: 10.1097/SCS.0000000000007080.
The aim of this study was to describe the clinical features and surgical results in a series of adult intact tympanic membrane cholesteatoma (ITMC).
The author retrospectively analyzed 17 adult patients diagnosed with ITMC who underwent surgery. The author investigated the demographic data, presenting symptoms, endoscopic findings, disease location, surgical technique, post-operative complications, and outcomes.
Diagnosis was made based on a white mass behind an intact tympanic membrane in 14 cases and on explorative surgery and CT in the remaining 3 patients. ITMC presented as a cystic lesion with a complete capsule. ITMCs were removed through an endoscopic endaural approach combined with cartilage myringoplasty in 14 cases and intact canal wall mastoidectomy was performed in 3 cases. No recurrent cholesteatoma or iatrogenic sensorineural hearing loss was observed during the follow-up period. The mean ABG was 17.7 ± 2.7 dB perioperatively and 10.2 ± 1.3 dB postoperatively.
Intact tympanic membrane cholesteatoma in adults may have both congenital and acquired origins, but it is not possible to differentiate between a slow growing acquired or indolent congenital cholesteatoma. ITMC typically presents as a cystic lesion with a complete capsule that can be treated successfully via an endoscopic tympanotomy approach, but in a minority of cases a more extensive mastoidectomy may be required.
本研究旨在描述一系列成人完整鼓膜胆脂瘤（ITMC）的临床特征及手术结果。
作者回顾性分析了17例接受手术的诊断为ITMC的成年患者。作者调查了人口统计学数据、临床表现、内镜检查结果、病变部位、手术技术、术后并发症及治疗效果。
14例根据完整鼓膜后白色肿物诊断，其余3例通过探查手术及CT诊断。ITMC表现为有完整包膜的囊性病变。14例行内镜耳道入路联合软骨鼓膜成形术切除ITMC，3例行完整外耳道壁乳突切除术。随访期间未观察到复发性胆脂瘤或医源性感音神经性听力损失。围手术期平均气骨导差为17.7±2.7dB，术后为10.2±1.3dB。
成人完整鼓膜胆脂瘤可能有先天性和后天性起源，但难以区分缓慢生长的后天性或惰性先天性胆脂瘤。ITMC通常表现为有完整包膜的囊性病变，可通过内镜鼓室切开术成功治疗，但少数情况下可能需要更广泛的乳突切除术。
