ENT - Cholesteatoma

Question 1

What is cholesteatoma?

Answer 1

An abnormal collection of squamous epithelial cells in the middle ear

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

Question 2

What is the main theory behind the pathophysiology of cholesteatoma?

Answer 2

Negative pressure in the middle ear caused by Eustachian tube dysfunction leads to retraction of the tympanic membrane into the middle ear

Squamous cells in this pocket continue to proliferate and grow into surrounding space, bones and tissues

Can damage the ossicles causing permanent hearing loss

Question 3

What are the typical presenting symptoms of cholesteatoma?

Answer 3

• Foul discharge from the ear
• Unilateral conductive hearing loss

Question 4

What additional symptoms may develop as cholesteatoma expands?

Answer 4

• Infection
• Pain
• Vertigo
• Facial nerve palsy

Question 5

What can otoscopy reveal in a patient with cholesteatoma?

Answer 5

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

Question 6

What imaging technique can confirm the diagnosis of cholesteatoma?

Answer 6

CT head

Used to confirm and plan for surgery

MRI can help assess invasion into local soft tissues

Surgical removal of cholesteatoma