Cholesteatoma

Question 1

What?

Answer 1

Abnormal accumulation of squamous epithelium and keratinocytes within middle ear or mastoid air cells

Question 2

Mechanism?

Answer 2

Keratin within middle ear -> becomes trapped -> builds up -> erodes bone surroundings as it expands

Question 3

What can this cause?

Answer 3

Keratin is medium for bacterial growth

Causes hearing loss, discharge, infective complications

Question 4

Risk factors?

Answer 4

Males
Middle ear disease
Eustachian tube dysfunction
Otological surgery or traumatic blast to ear
Congenital anomalies 
Family history 
Social deprivation
Bisphosphonates

Question 5

Clinical features?

Answer 5

Recurrent/ chronic purulent aural discharge
Discharge is malodorous and may be scant (insufficient amounts)
Hearing loss or tinnitus

Question 6

Less common symptoms?

Answer 6

Otalgia
Vertigo
Facial nerve (VII) involvement - altered taste or facial weakness

Question 7

Examination?

Answer 7

Ear discharge
Deep retraction pocket in tympanic membrane with/ out granulation tissue & skin debris
Crust or keratin
Perforated tympanic membrane
Defect in TM filled with white, cheesy material

Question 8

Investigations?

Answer 8

If suspected -> semi urgent referral to ENT

Audiology assessment and CT

Question 9

Management?

Answer 9

Aural discharge - topical antibiotics prior to surgery

Canal wall up mastoidectomy