0:01

I'd like to show this case as another example

0:03

of a patient who had been operated on for an

0:07

acquired cholesteatoma on the left side.

0:10

Let's look at it sequentially.

0:12

We look at the external auditory canal cartilaginous

0:14

portion, which looks fine.

0:16

We come to the external auditory canal,

0:18

we see that there's soft tissue thickening

0:20

along the external auditory canal.

0:22

And then we see this divot in the mastoid posterior

0:27

to the external auditory canal wall.

0:30

So because the posterior external auditory canal

0:36

wall is intact, it hasn't been removed.

0:39

This is a canal wall-up mastoidectomy.

0:44

So the posterior wall of the external auditory canal is up.

0:48

It's still there.

0:49

So that is the terminology of a canal wall-up mastoidectomy,

0:54

sometimes called a simple mastoidectomy.

0:57

So if we follow the mastoidectomy cavity,

0:59

we can see that it does enter into the middle

1:02

ear cavity. And the next thing that we notice,

1:04

in addition to the thickening of the

1:06

walls of the external auditory canal,

1:08

is the marked thickening of the tympanic membrane.

1:11

And then we see the absence of any middle ear

1:15

ossicles, so no ice cream tonight.

1:19

No ice cream cone tonight. No parallel lines.

1:23

We just have soft tissue in this patient who

1:25

has a recurrent cholesteatoma. Again,

1:29

miss eroded mass is the recurrent cholesteatoma.

1:34

You can see it's taken out portions of the

1:36

tegmen tympani here, going all the way up.

1:39

And so this is our more traditional pars flaccida cholesteatoma.

1:44

So I wanted to focus for a moment on the middle ear

1:50

ossicles. So this patient nonetheless was able to

1:54

hear out of the left ear, and you wonder, well,

1:57

how is that possible? So, by clinical history,

2:01

this patient had an ossiculoplasty, removal

2:05

of the ossicles, and had a total ossicular

2:08

replacement prosthesis put in. Now,

2:12

sometimes these TORPs (total ossicular

2:14

replacement prosthesis) are radiopaque.

2:17

Sometimes they are not made of radiopaque material.

2:21

And what you just see is something thickening...

2:24

some thickening going from the tympanic

2:26

membrane to the vestibule.

2:30

And this is effectively what we're seeing right here.

2:33

So this is the portion of the cochlea.

2:34

Here's the junction of the cochlea and the vestibule,

2:37

and you've got this soft tissue. Granted,

2:41

this patient has recurrent cholesteatoma,

2:43

but this tiny little strandiness right here

2:47

is likely the total ossicular replacement prosthesis,

2:51

which is made in this case of probably the

2:54

plastic rather than metallic material.

2:56

And it's surrounded here, as you can see,

3:00

by soft tissue of the cholesteatoma.

3:02

So just another example of a patient with a

3:07

cholesteatoma showing postoperative changes

3:11

of a canal wall-up mastoidectomy,

3:14

total ossicular replacement prosthesis whose

3:18

integrity we really can't say very much about

3:21

because of the recurrent cholesteatoma.