Objective: To detect the presence of intratympanic membrane cholesteatoma in cases of chronic otitis media. Design: Two hundred forty-three temporal bones from patients with chronic otitis media were studied for the presence of intratympanic membrane cholesteatoma. Methods: Specimens had been previously removed at autopsy, fixed in 10% buffered formalin, decalcified in trichloroacetic acid, dehydrated in a graded series of ethanol, and embedded in celloidin. Sections were cut at a thickness of 20 μm, stained with hematoxylin eosin, and examined using light microscopy. Results: Intratympanic membrane cholesteatomas were found in five of the 243 temporal bones with chronic otitis media. All temporal bones with intratympanic membrane cholesteatomas were from adult patients. Two patients had bilateral intratympanic cholesteatomas in symmetric quadrants of the tympanic membrane, and the remaining patients with unilateral intratympanic membrane cholesteatoma had been operated on previously for a cholesteatoma of the opposite ear. Other common findings included chronic granulation tissue in the middle ears and mastoids, ossicular pathologic conditions, and in four of the five ears, fluid in the middle ears and/or mastoids. Conclusion: When a white area is observed on the tympanic membrane of patients (especially those with “silent” chronic otitis media), differential diagnosis should include not only tympanosclerosis, but also intratympanic membrane cholesteatoma.