THE PURPOSE of this article is to call attention to the problem of "silent" cholesteatoma. It is not our intention to discuss the various theories of the formation of otogenic cholesteatoma; however, we do feel that none of the existing theories satisfactorily explains all cases. The one common finding in our group of cases was that at various stages or throughout the course of the otologic disease no perforation of the drum or attic was present. Complicating symptoms, such as labyrinthic fistula, can lead to a misdiagnosis of Ménière's disease; facial paralysis resembles Bell's palsy, and conductive deafness can be ascribed to otosclerosis, as in two recent cases of fenestration. Recent experiences with a large group of cases have made us alert to the existence of "silent" cholesteatoma as a causative factor in otherwise obscure otologic symptoms. The following cases were selected to illustrate this problem.
REPORT OF CASES
Case