title: [Missed diagnostic cholesteattomaous otitismedia].
abstract: OBJECTIVE
  To explore the missed diagnostic cholesteattomaous otitismedia lacked of clinical symptoms in order to minimize the mistake in clinical diagnose.
  
  
  METHODS
  A retrospective study of 31 cases with the missed diagnostic cholesteattomaous otitismedia, confirmed by surgery and pathology, was conducted.
  
  
  RESULTS
  Twenty-one cases (67.7%) had not obvious otorrhea. There were only slight finding such as attic retraction, apophysis, small granulation tissue, ear wax covered or tiny, even non, perforation in the pars flaccida or the superior and posterior pars tensa of the ear-drum. In general, the hearing loss is slight or medium conductive deafness. The type B curve was showed in tympanogram. The diagnosis rate of X-ray was only 41.9%, and 80.7% for the computed tomography. The middle ear structures aggressed by cholesteames was epitympanum, ossicular chain, tympanic antrum, mastoid process and mesotympanum. The complications occurred in 11 cases (35.5%) were the expose of facial nerve or and the meninges, or, and the labyrinth fistula.
  
  
  CONCLUSIONS
  The cases with the cholesteatoma lack obvious clinic symptoms would result in the missed diagnosis because of slow and long term during cholesteatoma development. Sometimes misdiagnosed or missed diagnosis happened to in such cases of cholesteatoma with little clinical manifestation, and it is so dangerous for the patients in such case. Therefore, otolaryngologist must pay more attention to the missed diagnostic cholesteattomaous otitismedia.
authors.affiliation: Department of Otorhinolarynology, Shanghai Fourth People's Hospital, Shanghai 200081, China. nizhsh@public2.sta.net.cn
authors.forename: Guansen
authors.initials: G
authors.lastname: Ni
authors.forename: Huadong
authors.initials: H
authors.lastname: Fan
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhu
authors.forename: Wenwen
authors.initials: W
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies