Cholesteatoma

Question 1

What is cholesteatoma?

Answer 1

Collection of benign growth of keratinising squamous cells that is trapped within the skull base causing local destruction

Question 2

Who does cholesteatoma affect?

Answer 2

Most common in patients 10-20 years

Assoc. with childhood chronic eustachian tube dysfunction

Congenital cholesteatoma = 5%

More common in males

Question 3

What are the signs and symptoms of cholesteatoma?

Answer 3

=> Persistent foul-smelling ear discharge despite topical antibiotics (non-resolving)

=> Unilateral hearing loss

=> Vertigo

=> Facial nerve palsy

=> Cerebellopontine angle syndrome

Question 4

Complications same as acute otitis media.

Answer 4

Look at acute otitis media

Question 5

How is cholesteatoma examined?

Answer 5

=> Microsuction to remove any wax and ensure all tympanic membrane is visualised

=> Otoscopy performed - look at superior left corner (pars flaccida - weakest part of the tympanic membrane) of the tympanic membrane

=> Deep retraction pocket in the tympanic membrane with keratinous debris + adjacent bony erosions

=> Discharge if secondary infection present

=> Congenital cholesteatoma = tympanic membrane intact but may be bulging + white pearly mass visible through the membrane

Question 6

What are the investigations for cholesteatoma?

Answer 6

Pure tone audiometry

CT scan of the temporal bone

Question 7

What is the treatment for cholesteatoma?

Answer 7

ENT referral for surgical removal of cholesteatoma sac + repair tympanic membrane, adjacent bony defect to prevent recurrent discharge.