A 14-year-old boy underwent canal wall up mastoidectomy with posterior tympanotomy for cholesteatoma. At two-year follow-up, a residual pearl is found deep in the middle ear. In which hidden recess is such residual disease most often missed?

• A Sinus tympani ✓
• B Mesotympanum anterior to the malleus
• C Hypotympanum
• D Supratubal recess

Explanation

The sinus tympani lies medial to the facial nerve and deep to the pyramidal eminence, and it cannot be fully inspected directly even through a posterior tympanotomy. Disease seeded there at the first operation is therefore the commonest source of residual cholesteatoma after canal wall up surgery, which is why second look procedures are advocated. The hypotympanum, anterior mesotympanum and supratubal recess are all visible through standard approaches and are less frequently implicated.

Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.