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Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Dec 29, 2015

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Felix Gallagher
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Page 1: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Cholesteatoma

Page 2: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular

chain and tympanoplasty

Page 3: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

SRT/WR

Page 4: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Audio

Page 5: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Cholesteatoma Case 2

58 y/o female Hx of bilateral cholesteatoma Hx of multiple bilateral ossicular chain

reconstructions, stapedectomy and tympanoplasty

Hx of mastoidectomy

Page 6: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 7: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 8: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 9: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Cholesteatoma Case 3

57 y/o male Hx of Left tympanoplasty,

mastoidectomy, and ossicular chain reconstruction

Page 10: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 11: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 12: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 13: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 14: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Cholesteatoma Case 4 History

12 y/o Male History of right cholesteotoma Hx of Eustachian Tube dysfuction Removed cholesteotoma and placed

subannular tubes in May 04

Page 15: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Bilateral atelactasis No tubes Pin point perferation right?

Page 16: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 17: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 18: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 19: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 20: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 5 History

62 year old female Recent right tympanoplasty and

ossicular chain prosthesis placement 6 months prior

Page 21: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Right reveals a well healed tympanic graft

Left is within normal limits

Page 22: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 23: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 24: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 25: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Cholesterol granuloma History

41 year old male Six to eight week history of low-grade left

sided headaches – aggrivated by straining and valsalva.

Recent transient stabbing type pain in left temporal area

Sent to Shands after a CT scan showed a cholesterol granuloma – for biopsy/draining

Page 26: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

CT Scan (note our patient has it on the opposite side, it is in the middle ear space)

Page 27: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

There are exostoses in both ear canals obscuring full view of TM

Page 28: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 29: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 30: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 31: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 32: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 6 History

79 year old male Recent tympanoplasty and canaloplasty

for a right cholesteatoma

Page 33: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Pnematic otoscopy reveals grade 4 atelactasis left posterosuperior tympanic membrane with no evidence of cholesteatoma

Right TM is intact

Page 34: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 35: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 36: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 37: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 38: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 7 History

13 year old female History of left cholesteatoma Underwent tympanoplasty, modified

radical mastoidectomy and ossicular chain reconstruction 3 years prior

Page 39: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Granulation tissue found in left mastoid bulb – cauterized with silver nitrate

TM on left within normal limits Right TM has developed a retraction of

the pars flaccida onto the incus and pars tensa onto the promontory.

Weber lateralizes to the right

Page 40: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 41: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 42: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 43: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 44: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 8 History

65 year old female History of right traumatic perforation

with subsequent cholesteatoma Right tympanoplasty, bony canaloplasty

and ossicular chain reconstruction

Page 45: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Left is within normal limits Right external auditory canal showed

scant dry skin and residue from sterois drops – removed

Graft is healed and there is no evidence of cholesteatoma

Page 46: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 47: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 48: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 49: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 9 History

Preoperative consultation for possible left cholesteatoma

History of chronic ear infections Imaging done one month prior showed

soft tissue density consistent with cholesteatoma

Page 50: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Right is within normal limits Left TM is inflamed and opacified

Page 51: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 52: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 53: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 54: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 10 History

69 yr old male current Right TM perf Hx of left TM perf with

canaloplasty/tympanoplasty performed on the left ear

Synthetic ossicular chain reconstruction with stapedectomy in Aug 2005

Page 55: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 56: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 57: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 58: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 11 History

65 y/o male Motor Vehicle Accident (MVA) Sept ‘01 Right temporal bone fracture with right

sided paralysis of face

Page 59: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 60: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 61: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 62: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 63: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 12 History

14 y/o female Fell off the back of a pickup truck going

approx 30 mph Left temporal bone fracture she currently has bleeding from the left

ear canal

Page 64: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Skin laceration on skin of left external auditory canal

Left TM seems intact but there is evidence of hemotympanum

Page 65: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 66: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 67: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 68: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 69: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 13 history

21 year old female History of left cholesteatoma with

tympanoplasty, ossicular chain reconstruction and tympanomastoidectomy three months prior

Page 70: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Right is within normal limits Left shows no retraction pockets and

seems to be healing well

Page 71: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 72: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 73: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 74: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 75: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Case 14 History

76 year old female Four months post left canaloplasty,

tympanoplast and ossicular chain reconstruction

Page 76: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.

Otoscopy

Right is within normal limits Left TM is dull

Page 77: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 78: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 79: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.
Page 80: Cholesteatoma. Case History Ossicular Reconstruction Cholesteatoma Case 1 12 yr old male Left Congenital Cholesteatoma Surgical Reconstruction of ossicular.