Cholesteatoma Flashcards
Ear discharge
What is cholesteatoma?
A destructive growth of keratinising squamous epithelium in the middle ear/mastoid
= is a complication of chronic otitis media
What is the most common cause of acquired cholesteatoma?
Chronic otitis media or a perforated tympanic membrane
What is a key risk factor for developing cholesteatoma?
A history of frequent ear surgery
What happens as cholesteatoma expands?
It erodes the surrounding bone
What is the most common symptom of cholesteatoma?
(1) Persistent
(2) Foul-smelling
(3) Unilateral offensive ear discharge for more than 6 weeks
(4) Tinnitus
What is seen on histology for cholesteatoma?
Squamous epithelium with abundant keratin production and inflammation
What type of hearing loss is associated with cholesteatoma?
Conductive hearing loss
What are the severe complications of cholesteatoma?
(1) Vertigo
(2) Sensorineural hearing loss
(3) Facial nerve palsy
(4) Meningitis
(5) Intracranial abscess
What is seen on otoscopy in cholesteatoma?
Tympanic membrane retraction and white, cheesy debris filling the defect
What is the definitive treatment for cholesteatoma?
Mastoid surgery to remove the sac of debris and reconstruct the area
What is the management of Ramsay Hunt syndrome (type II)?
(1) 7 days of high dose (60mg) prednisolone (with gastric protection)
(2) Aciclovir
What is a potential complication of mastoid surgery?
Permanent unilateral facial weakness
A 20-year-old man presents to his GP complaining of foul-smelling discharge from the right ear.
It has been persistent for the past three months and progressively worsening. He is particularly aware of the discharge upon waking, as it covers his pillow. He does not report any ear pain, but some hearing problems in the right ear. On examination, there are no signs of focal neurology.
What is the definitive management for the most likely diagnosis?
Surgical
A 56-year-old gentleman presents to his GP with long-standing left-sided otorrhoea. He has not previously sought help as he felt embarrassed by the foul smell of the discharge. On otoscopy, the superior aspect of the left tympanic membrane retracts, alongside which a brown crust-like mass is seen. Tuning fork tests reveal a slight conductive hearing loss despite the patient not reporting this in the history.
What is the most appropriate investigation to confirm the diagnosis?
High-resolution CT scan of the petrous temporal bone
A 14-year-old girl presents to the outpatient clinic with an 8-month history of left-sided hearing loss and painless otorrhoea. Her symptoms have not improved despite multiple courses of topical antibiotics.
What is the most likely diagnosis?
Cholesteatoma
A 52-year-old man received an otological diagnosis after several years of not seeing his GP for aural fullness and persistent foul-smelling discharge from his right ear as he wanted to persist with using natural remedies
What is the most likely complication of the underlying diagnosis if this condition remains untreated?
Conductive hearing loss
A 49-year-old Caucasian male presents with a 12-week history of pus-like discharge from his ear. You decide to perform an otoscopy. What is the most important part of the tympanic membrane to visualise?
Attic
Where is ‘attic crust’ seen?
Seen in the uppermost part of the eardrum
What is the cause of Ramsay Hunt Syndrome?
Reactivation of varicella-zoster virus (VZV)
= in the geniculate ganglion of
CN VII - facial nerve
What are the features of Ramsey hunt syndrome?
(1) Auricular pain
= often the first symptom
(2) Facial nerve palsy
= on the same side
(3) Vesicular rash around the ear, face, or mouth
(4) Vertigo and tinnitus may be present
