Cholesteatoma

Last reviewed: 27 Aug 2022
Last updated: 26 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • hearing loss
  • ear discharge resistant to antibiotic therapy
  • attic crust in retraction pocket
  • white mass behind intact tympanic membrane
More key diagnostic factors

Other diagnostic factors

  • tinnitus
  • otalgia
  • altered taste
  • dizziness
  • facial nerve weakness
Other diagnostic factors

Risk factors

  • middle ear disease
  • eustachian tube dysfunction
  • otological surgery
  • traumatic blast injury to ear
  • congenital anomalies
  • family history
More risk factors

Diagnostic investigations

1st investigations to order

  • pure tone audiogram
  • CT scan of the petrous temporal bones
More 1st investigations to order

Investigations to consider

  • fistula test
  • MRI scan of the head and petrous temporal bones
  • bacterial culture
More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Susan A. Douglas, MBBS (Hons) UWI, FRCSEd, FRCS (ORL-HNS)

Consultant Otolaryngologist and Otologist

Rotherham NHS Foundation Trust

Rotherham

UK

Disclosures

SAD declares that she has no competing interests.

Peer reviewers

Cliff Megerian, MD

Professor and Vice Chairman of Otolaryngology

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

CM is an author of a reference cited in this topic.

Iain Swan, MD, FRCS

Senior Lecturer in Otolaryngology

Honorary Consultant Otolaryngologist

Glasgow Royal Infirmary

Glasgow

UK

Disclosures

IS declares that he has no competing interests.

  • Cholesteatoma images
  • Differentials

    • Chronic suppurative otitis media
    • Otitis externa
    • Benign necrotising otitis externa
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: hearing loss and/or vertigo
    • Imaging of non-operated cholesteatoma: clinical practice guidelines
    More Guidelines
  • Patient leaflets

    Meningitis and septicaemia

    Middle ear infection

    More Patient leaflets
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