Cholesteatoma

Question 1

What is a cholesteatoma?

Answer 1

Abnormal skin growth - sac or cyst of keratinising squamous epithelium growing into the middle ear behind the TM

Question 2

Is it cancerous?

Answer 2

No - a non cancerous growth of squamous epithelium that is trapped and causes local destruction

Question 3

Amongst what age is it most common?

Answer 3

10-20 years

Question 4

What are associated symptoms?

Answer 4

Painless
Foul smelling otorrhea
Hearing loss 
Other features determined by local invasion: 
Vertigo
Facial nerve palsy
Cerebellopontine angle syndrome

Question 5

What is it usually secondary to?

Answer 5

Chronic Eustachian tube dysfunction or chronic/recurring ear infections

Question 6

What structures can it erode into?

Answer 6

Ossicles
Mastoid bone
Cochlea

Question 7

What is seen with otoscopy?

Answer 7

Attic crust - seen in the uppermost part of ear drum

Question 8

How is it managed?

Answer 8

Refer to ENT for consideration of surgical removal

Microsuction and direct inspection needed, so referral required

Question 9

Cholesteatoma can erode neighbouring structures and also become…

Answer 9

Infected - leading to mastoiditis, cerebral abscess, meningitis