title: Transcanal CO2 laser-enabled ablation and resection (CLEAR) for intratympanic membrane congenital cholesteatoma.
abstract: OBJECTIVE
  Cholesteatoma in the tympanic membrane is frequently regarded as congenital but there has been no case series review or comparison study with typical pediatric congenital cholesteatoma (CC).
  
  
  METHODS
  All pediatric CC cases from 2009 to 2014 were collected, and a total of 10 cases of intratymapnic membrane CC (ICC) out of 429 CC cases were reviewed. They were compared with 14 cases of iatrogenic intratympanic membrane keratin after pediatric CC surgery (IIKC).
  
  
  RESULTS
  ICC constituted 2.3% (10/429) of CCs, and the median age of operation was 24 months, 12 months earlier than that for CC. ICC failed to show male preference which is found in both CC and IIKC. As CC is commonly abutting the medial side of malleus, almost 90% of ICCs were found abutting the umbo of malleus. However, IIKC was usually located at the epithelial trauma site during the CC surgery without malleus abutment. Except in case of spontaneous resolution, the other cases of ICC and IIKC were treated by minimally invasive transcanal CO2 laser-enabled ablation and resection (CLEAR) alleviating any ossicle vibration trauma, incision or graft harvest. All patients retained normal hearing without complication and recurrence.
  
  
  CONCLUSIONS
  ICC might be a rare variant of early detectable pediatric CC estimated from its location close to the ossicle and the surgical findings, but without sex preference. Although ICC shares morphologic similarity with IIKC, their locations of development are different, thereby suggesting different pathogenesis rather than epithelial injury. However, CLEAR surgery can be a good treatment option for intratympanic membrane lesions.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
authors.forename: Chang-Ho
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
authors.forename: Chan Kee
authors.initials: CK
authors.lastname: Yoo
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
authors.forename: Hyoung-Mi
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. Electronic address: jcahn@cha.ac.kr.
authors.forename: Jae-Cheul
authors.initials: JC
authors.lastname: Ahn
mesh_terms: D002675:Child, Preschool; D002781:Cholesteatoma / Q000151:congenital* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology* / Q000601:surgery
keywords: Cholesteatoma; Congenital; Keratins; Lasers; Tympanic membrane