Cholesteotoma

Question 1

Pathophysiology of cholesteotomas

Answer 1

Abnormal collection of squamous epithelial cells in the middle ear

Question 2

Complications of cholesteotomas

Answer 2

Non-cancerous but can invade local tissues and nerves and erode the bones of the middle ear.

Predispose to significant infections - otitis media

Question 3

Presentation of cholesteotomas

Answer 3

Foul discharge from the ear

Unilateral conductive hearing loss

Persistent otitis media

As it grows:

• Infection
• Pain
• Vertigo
• Facial nerve palsy

Question 4

Investigations for a cholesteotoma

Answer 4

Otoscopy - debris in attic of tympanic membrane

CT head - confirm the diagnosis and plan for surgery

MRI may help assess invasion and damage to local soft tissues.

Question 5

Management of a cholesteotoma

Answer 5

Surgical removal of the cholesteatoma

Question 6

Risks of surgery

Answer 6

Further hearing loss
Tinnitus
Facial weakness

Question 7

Risk factors for cholesteotoma

Answer 7

Male 
Bisphosphonates 
Eustachian tube dysfunction 
Down syndrome 
Turners syndrome