Cholesteatoma

Question 1

What is cholesteatoma?

Answer 1

Special form of chronic otitis media in which keratinising squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid

Question 2

What are the clinical features of cholesteatoma?

Answer 2

• Asymptomatic
• Painless otorrhoea - scant, foul-smelling discharge from the affected ear
• Conductive hearing loss

Other features may include:

• vertigo
• facial nerve palsy

Question 3

What are the otoscopic findings in cholesteatoma?

Answer 3

• Retraction pocket with squamous epithelium and debris that often appears as a brown, irregular mass

Question 4

What is the management of cholesteatoma?

Answer 4

Surgery - always indicated due to risk of complications

• excision of cholesteatoma
• reconstruction of middle ear structures if required

Question 5

What are the potential complications of cholesteatoma?

Answer 5

• Destruction of the ear ossicles
• Perilymph fistula
• Facial nerve paralysis
• Erosion of temporal bone leading to extradural abscess, meningitis, sigmoid sinus thrombosis
• Aural polyp