European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1069–1075 | Cite as

Endoscopic visualization to the anterior surface of the malleus and tensor tympani tendon in congenital cholesteatoma

  • Bong Jik Kim
  • Jung Ho Kim
  • Moo Kyun Park
  • Jun Ho Lee
  • Seung-ha Oh
  • Myung-Whan Suh



This study evaluated the feasibility of endoscopy in exposing the anterior surface of the malleus and tensor tympani tendon (ASMT) in children with congenital cholesteatoma (CC), and investigated the outcomes of hearing, postoperative complications, and residual or recurrent disease in endoscopic surgical approach cases.


A retrospective case review was performed in one tertiary referral center. Twelve children with CC involving the ASMT were recruited, and their medical records were reviewed. All patients underwent either total endoscopic surgery (n = 3) or endoscope-assisted surgery (n = 9), and Potsic staging was adopted to classify CC according to its severity: stage I (n = 8), stage II (n = 2), and stage III (n = 2). The mean follow-up period was 15.5 ± 2.8 months. The visibility of the ASMT by endoscope assistance, audiological results, surgical and postoperative complications, and recidivism of CC were analyzed.


The ASMT was well visualized by endoscope assistance in all cases. No patient showed hearing deterioration at 3 months after surgery, and none experienced residual or recurrent disease during the follow-up period. Postoperative complications were not observed.


Total endoscopic or endoscope-assisted surgery could help surgeons directly visualize the ASMT in children, with negligible risks of hearing deterioration, postoperative complications, and recurrent disease. Our study might suggest that endoscopic ear surgery should be considered in patients with CC in the ASMT.


Congenital cholesteatoma Endoscope Malleus Tensor tympani tendon Potsic staging 



This study was supported by the National Research Foundation of Korea grant funded by the Korea government (no. NRF-2017R1C1B3005431).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval of the Institutional Review Board at the hospital was obtained for this retrospective study (SNUH 2016-3449).

Supplementary material

405_2018_4917_MOESM1_ESM.tif (6.9 mb)
Supplementary Figure 1. Representative pathology images of CC with or without inflammatory cells. Keratin materials without inflammatory cells comprising CC (A) and CC showing inflammatory cells (predominantly lymphocytes) (B). (TIF 7103 KB)
405_2018_4917_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Bong Jik Kim
    • 1
    • 2
  • Jung Ho Kim
    • 3
  • Moo Kyun Park
    • 1
  • Jun Ho Lee
    • 1
  • Seung-ha Oh
    • 1
  • Myung-Whan Suh
    • 1
  1. 1.Department of Otorhinolaryngology-Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Otolaryngology-Head and Neck Surgery, College of MedicineChungnam National UniversityDaejeonRepublic of Korea
  3. 3.Department of PathologySeoul National University HospitalSeoulRepublic of Korea

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