Cholesteotoma

Question 1

What is Cholesteatoma?

Answer 1

Cholesteatoma = non-cancerous growth of squamous epithelium ‘trapped’ within skull base (within middle ear cleft and mastoid air cells) = local destruction

Serious and rare complication of chronic otitis media
Can be asymptomatic in early stages
Most common 10-20 years old
Born with cleft palate = increased risk by 100 fold

Question 2

Main features of cholesteatoma?

Answer 2

Foul smelling, non-resolving discharge
Hearing loss (conductive)
Otalgia
Headache

Question 3

Other features determined by local invasion:

Answer 3

Vertigo
Facial nerve palsy
Cerebellopontine angle syndrome

Question 4

Complications of cholesteotoma

Answer 4

tumour can be locally invasive and destructive = serious complications (facial nerve palsy and CNS complications including meningitis, epidural abscess, sigmoid sinus thrombosis)
Requires emergency admission

Question 5

Diagnosis of cholesteotoma

Answer 5

Diagnosis requires clear visualisation of tympanic membrane (otoscopy), if tympanic membrane seen cholesteatoma suspected if:
Ear discharge
Presence of deep retraction pocket with/without granulation tissue/skin debris
Crust/keratin in upper part of tympanic membrane ‘attic crust’
Tympanic membrane may be perforated

Question 6

Management

Answer 6

referred to ENT for consideration of surgical removal
If significant discharge occlude tympanic membrane micro-suctioning may be appropriate