title: Cholesteatoma behind an intact tympanic membrane in adult life: congenital or acquired?
abstract: BACKGROUND
  Congenital cholesteatoma occurring behind the tympanic membrane is typically located in the anterior middle ear.
  
  
  OBJECTIVE
  To investigate the location, clinical features and treatment of cholesteatomas located behind an intact tympanic membrane in adults.
  
  
  METHODS
  Review of a series of 265 consecutive, new, adult cases of previously untreated cholesteatoma seen by the author over a 22-year period.
  
  
  RESULTS
  Seventeen (6 per cent) cases were located behind an intact tympanic membrane without any evidence of a retraction pocket of the attic or pars tensa. Ten (59 per cent) of these patients had undergone previous ear surgery and therefore the disease could reasonably be considered to be iatrogenic. The most common presentation was conductive deafness with no other symptoms (71 per cent). In all of the cases, the disease was located in the posterior half of the middle-ear space. The most common surgical management was simple excision of the disease via a tympanotomy. Two cases (12 per cent) developed residual disease.
  
  
  CONCLUSIONS
  The majority of the cases in this series were likely to be acquired cholesteatomas. This type of disease often presents with conductive hearing loss alone.
authors.affiliation: Otolaryngology Unit, University of Edinburgh, Scotland, UK. r.mills@ed.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002781:Cholesteatoma / Q000150:complications / Q000151:congenital / Q000473:pathology*; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013997:Time Factors; D014432:Tympanic Membrane / Q000033:anatomy & histology; D055815:Young Adult