Cholesteatoma and Mastoiditis Flashcards
What is cholesteatoma?
Destructive and expanding growth of keratinizing squamous epithelium within the middle ear and/or mastoid process.
What causes cholesteatoma?
Congenital – keratin filled cysts growing medial to tympanic membrane. Being born with a cleft palate increases the risk of cholesteatoma 100 fold.
Acquired – keratin accumulates in a pouch of tympanic membrane extending into the middle ear. Often this is as a result of Eustachian tube dysfunction or chronic otitis media.
What are the signs and symptoms of cholsteatoma?
Two classical symptoms that if present point to cholesteatoma until proven otherwise:
- Otorrhoea – foul smelling
- Conductive hearing loss
Pain and headache
Balance problems
Tinnitus and vertigo
Facial nerve palsy
How is cholesteatoma managed?
Surgical removal – have to balance risk of complications
2 parts to the surgery – complete removal of cholesteatoma and reconstructing middle ear canal and middle ear cavity.
What complications can occur form cholsteatoma?
Must have close monitoring post operatively due to high recurrence rates
If left untreated – erosion of the ossicles and/or labyrinth, meningitis, cerebral abscess, mastoiditis and cranial nerve paralysis
What is mastoiditis
An infection that spreads to the air cells of the skull behind the ear and abscess formation.
What organisms usually cause mastoiditis?
Strep pneumonia Strep pyogenes Staph aureus Haemophilus influenzae Moraxella catarrhalis
Usually occurs due to untreated otitis media
What are the signs and symptoms of mastoiditis?
Fever and systemically unwell
Pain, erythema and tenderness behind and around the ear
Pinna extension
Non-specific symptoms such as anorexia, diarrhoea, and irritability
Brown discharge on the pillowcase upon waking
History of recurrent otitis media
What investigations should be done in a patient suspected of having mastoiditis?
Clinical diagnosis
Confirmation by MRI or CT scan
Culture of any discharge
How is mastoiditis managed?
Analgesics
IV antibiotics
If antibiotics work slow then a small drain can be put in place
Definitive treatment is mastoidectomy
What complications can occur from mastoiditis?
Hearing loss Labyrinthitis Facial nerve palsy Abscess formation Meningitis Epidural abscess Thrombosis Brain abscess
