Clinical features of temporal bone cholesteatoma are miscellaneous, and sometimes misleading: signs of middle ear cholesteatoma, progressive or sudden facial palsy, sensorineural deafness as in acoustic neuroma, conductive deafness as in otosclerosis, secretory otitis media, or intracranial complications. Polytomography is the only way to pinpoint topography and extension. CT scanning is very useful in determining extension. Topography and severity of deafness are the guidelines for surgical approach. Among sixteen cases, total deafness was produced by the lesion itself in ten cases, and six had an intact inner ear; preservation of hearing was possible in only three. Supralabyrinthine cholesteatomas (five cases) are best managed by the middle fossa approach. Infralabyrinthine cholesteatomas (six cases) must be removed via the infratemporal approach with anterior displacement of the tympanic and mastoid segments of the facial nerve and permanent obliteration of the middle ear. Posterior perilabyrinthine cholesteatoma (five cases) may be removed by the otologic approach combined with the middle ear fossa approach if the inner ear is to be preserved. If hearing loss is total, the translabyrinthine approach can be used.
颞骨胆脂瘤的临床特征多种多样，有时具有误导性：中耳胆脂瘤的体征、进行性或突发性面瘫、如听神经瘤般的感音神经性耳聋、如耳硬化症、分泌性中耳炎般的传导性耳聋，或颅内并发症。多层体层摄影术是确定病变部位和范围的唯一方法。CT扫描在确定病变范围方面非常有用。耳聋的部位和严重程度是手术方法的指导依据。16例中，10例因病变本身导致全聋，6例内耳完好；仅3例有可能保留听力。上迷路胆脂瘤（5例）最好采用中颅窝入路处理。下迷路胆脂瘤（6例）必须通过颞下入路切除，同时将面神经的鼓室段和乳突段向前移位，并永久性闭塞中耳。如果要保留内耳，后迷路周围胆脂瘤（5例）可通过耳科入路结合中耳窝入路切除。如果听力完全丧失，可采用经迷路入路。
