JANUARY 18TH, 2023
Cholesteatoma Abnormal keratinizing squamous epithelium growth in middle ear and/or mastoid bone that can enlarge and erode through surrounding tissue or become infected.
Presenting Symptoms: Slow-onset, unilateral otorrhea, conductive hearing loss, or dizziness
Epidemiology: Incidence estimated to be 6 per 100,000 (1.4:1, M:F)
Etiology/Pathophysiology: Benign, invasive keratinized squamous epithelium accumulating in middle ear (congenital or acquired) associated with infection and bone erosion. Cholesteatoma is most commonly acquired and arises from tympanic membrane (TM) retraction or perforation.
Diagnosis: Direct visualization of white keratinaceous debris on otoscopy or otomicroscopy. Acquired cholesteatomas are usually located in posterosuperior quadrant with associated TM dysfunction, while those of congenital origin are typically located in the anterosuperior quadrant of the TM
Treatment: Surgery (Tympanomastoidectomy) with extent of surgery balancing complete removal and preservation of hearing and ear hygiene; 5-50% postoperative recurrence rate
Primary Acquired
Anil K. Lalwani: Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery, Fourth Edition Copyright McGraw-Hill Education. All rights reserved.
Congenital
Sergi B, Fetoni A. Images in clinical medicine. Congenital cholesteatoma of the middle ear. N Engl J Med. 2010
Coronal CT, pars flaccida cholesteatoma
Anil K. Lalwani: Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery, Fourth Edition Copyright McGraw-Hill Education. All rights reserved.
Further Reading:
Written by: Graham Pingree
