Cholesteatoma

Question 1

What is a cholesteatoma?

Answer 1

Skin or squamous epithelium growing in the middle ear

Question 2

What is the pathophysiology of cholesteatoma?

Answer 2

Retraction pocket of tympanic membrane pulled back by negative pressure in the Eustachian tube

Question 3

What are risk factors for developing a cholesteatoma?

Answer 3

Middle ear disease
ET dysfunction
Congenital abnormalities

Question 4

What are symptoms of a cholesteatoma?

Answer 4

Conductive hearing loss
Offensive discharge
Tinnitus
Otalgia

Question 5

What is seen on otoscopy?

Answer 5

Perforation of the pars flaccida with pearly white discharge

Question 6

What investigations should be done with those with suspected cholesteatoma?

Answer 6

CT scan of petrous temporal bones – assess for complications

Pure tone audiometry
- conductive hearing loss

Question 7

How is cholesteatoma managed?

Answer 7

Refer to ENT
Surgery – removal of cholesteatoma
+/- antibiotics

Question 8

What advice is given to patients with cholesteatoma?

Answer 8

Often reoccur – come back if discharge or hearing loss

Can get vertigo when swimming post-surgery – use ear plugs

Question 9

How are patients with cholesteatoma followed up?

Answer 9

Follow up surgery 9-12 months later

Regular ENT follow up

Question 10

What are potential complications with cholesteatoma?

Answer 10

Recurrence
Hearing loss
Labyrinthine fistula
Facial palsy