ENT - cholesteatoma

Question 1

What is a cholesteatoma?

Answer 1

An abnormal collection of squamous epithelial cells in the middle ear.

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

It can predispose to significant infections.

Question 2

What is the pathophysiology of cholesteatoma?

Answer 2

Not fully understood

The main theory is that negative pressure in the middle ear, caused by Eustachian tube dysfunction, causes a pocket of the tympanic membrane to retract into the middle ear. Essentially, a small area of the tympanic membrane gets sucked inwards.

The squamous epithelial cells of this pocket continue to proliferate and grow into the surrounding space, bones and tissues.

It can damage the ossicles (the tiny bones of the middle ear involved in hearing), resulting in permanent hearing loss.

Question 3

Presentation of cholesteatoma

Answer 3

Foul smelling discharge from the ear
Unilateral conductive hearing loss

Symptoms caused by local invasion:

• Vertigo
• Pain
• Facial nerve palsy

Question 4

Investigations in suspected cholesteatoma

Answer 4

Rinne’s and Weber’s

Otoscopy

Question 5

What would otoscopy show in cholesteatoma?

Answer 5

abnormal build-up of whitish debris or crust in the upper tympanic membrane.

However, it may not be possible to visualise the eardrum if discharge or wax are blocking the canal.

Question 6

Management of suspected cholesteatoma

Answer 6

Refer to ENT for consideration of surgery

A CT head can be used to confirm the diagnosis and plan for surgery.

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

Treatment involves surgical removal of the cholesteatoma.