Cholesteatoma

Question 1

What is a Cholesteatoma?

Answer 1

A non-cancerous abnormal collection of Squamous Epithelial cells in the middle ear.

Question 2

Why can it predispose to significant infections?

Answer 2

It can invade local tissues and nerves and erode the bones of the middle ear.

Question 3

Risk Factors of Cholesteatoma (2).

Answer 3

1. Commonest : 10-20.

2. Birth with Cleft Palate.

Question 4

Pathophysiology of Cholesteatoma.

Answer 4

1. Squamous Epithelial cells originate from outer surface of Tympanic Membrane.
2. Negative pressure in Middle Ear caused by Eustachian tube Dysfunction causes a pocket of Tympanic Membrane to retract into middle ear.
3. The pocket cells continue to proliferate and invade.

Question 5

Clinical Features of Cholesteatoma (2).

Answer 5

1. Foul Discharge from Ear.
2. Unilateral Conductive Hearing Loss.
3. Invasive Symptoms : Infection, Pain, Vertigo, Facial Nerve Palsy.

Question 6

Investigations of Cholesteatoma (3).

Answer 6

1. Otoscopy.
2. CT Head - Confirm Diagnosis and Plan Surgery.
3. MRI - Assess Invasion and Damage to Local Soft Tissues.

Question 7

Otoscopy Finding of Cholesteatoma.

Answer 7

ATTIC CRUST - Abnormal Build-up of Debris/Crust in Upper Tympanic Membrane and Wax/Discharge Blocks Eardrum.

Question 8

Management of Cholesteatoma.

Answer 8

ENT Referral : Surgical Removal of Cholesteatoma.