Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid.
Although benign, it may enlarge and invade adjacent bone.
Often presents with a malodorous ear discharge with associated hearing loss.
Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent.
Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively.
Complications include hearing loss, recurrence, meningitis, facial palsy, and a labyrinthine fistula.
Cholesteatoma is defined as the presence of keratinising squamous epithelium within the middle ear, or in other pneumatised areas of the temporal bone. This keratinising epithelium exhibits independent growth, leading to expansion and to resorption of underlying bone. Focal erosion of external canal bone with accumulation of keratin is called external canal cholesteatoma.
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
Other diagnostic factors
- altered taste
- facial nerve weakness
- middle ear disease
- eustachian tube dysfunction
- otological surgery
- traumatic blast injury to ear
- congenital anomalies
- family history
1st investigations to order
- pure tone audiogram
- CT scan of the petrous temporal bones
Investigations to consider
- fistula test
- MRI scan of the head and petrous temporal bones
- bacterial culture
- Chronic suppurative otitis media
- Otitis externa
- Benign necrotising otitis externa
- ACR appropriateness criteria: hearing loss and/or vertigo
- Imaging of non-operated cholesteatoma: clinical practice guidelines
Meningitis and septicaemia
Middle ear infectionMore Patient leaflets
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