ME Disorders (Cholesteatoma) Flashcards
what is a cholesteatoma
“pseudotumors” that can occupy the external ear canal, ME cavity, or extend through the mastoid bone into the brain cavity
how do cholesteatoma manifest
manifest highly aggressive, progressively enlarging, tumor-like characteristics
how do they manifest/fxn like a tumor
They are highly erosive and may cause destruction of bone and other tissue
Recently, highly invasive fibroblasts were found in cholesteatoma that are not seen in normal skin, which may explain the aggressive behavior of a cholesteatoma
Cholesteatoma can be
congenital or acquired
what is a congenital cholesteatoma
Almost always present in children
Median age is ~ 5 years
3:1 male to female ratio
The TM can be normal without a history of perforation, otorrhea, or myringotomy
Most common location is the anterior-superior quadrant
Etiology is controversial
what are acquired cholesteotoma
More common than congenital
Often due to chronic or untreated otitis media with effusion or trauma leading to TM perforation
Also occurs as a result of TM retraction in the pars flaccida or posterior-superior quadrant
Previous ear surgery/TM perforation also may be the growth site
Slow growing condition, initially with no symptoms
Usually presents first with a hearing loss
what are iatrogenic cholesteatomas
May result because of a blunt knife used during myringotomy
May lead to implantation of squamous epithelium in ME cavity
how do chol grow
by forming a keratinized epithelial layer and a fibrous subepithelial layer called a matrix
What forms a keratoma
Keratin (dead skin cells and debris) builds up and gets covered by cells
what does a keratoma do
evoke inflammatory reaction leading to formation of a cholesteatoma, mostly in the attic area of the ME cavity
how does cholesteatoma result in mastoiditis
they will grow, engulf, and erode the ossicles, bones of the tympanic cavity
A cholesteatoma can become
secondarily infected producing otorrhea (foul smelling discharge)
iatrogenic
something related to surgery procedures
if large enough, can exert pressure on CN VII causing
causing facial palsy
what type of tymp would you see with cholesteatomas
depends on size, location & how much it has damaged
normal tymp
no damage
type as
cholesteatoma is filling the ME cavity; a stiffness dominated system
type ad
If ossicular disarticulation has occurred t
type b flat with low volume
If it has caused TM peroration and is filling up the ME cavity
type b high volume
If the cholesteatoma is not big enough to fill up the ME cavity and TM perforation is present
Auditory sensitivity varies depending on
underlying damage
Hearing is normal
if the ossicular chain is intact and the cholesteatoma only caused TM perforation or no perforatio
chl
f ossicular disarticulation occurred
Mixed hearing loss
if goes into the inner ear
what are PT complaints of cholesteatoma
Foul smelling discharge and often bleeding
Hearing loss verified by an audiologic evaluation
Otalgia, headache, or occasionally mild dizziness
is diagnosis difficult of cholesteatoma
Usually diagnosis is not difficult because it can be visualized on a microscopic exam of the ear in the physician’s office
why ct scan is done
To identify potential damage caused by the cholesteatoma, including facial nerve dehiscence and ossicular damage, for better patient counseling
But many otologists do not order a CT scan because it does not change the management
what is the primary treatment
surgical removal
why do they not like bleeding into the surgical site
makes it harder to see
why are antibiotic steroid drops prescribed prior to surgery
decrease inflammation and granulation tissue, which decreases bleeding during surgery
surgery can result in
HL (tm and ossicles may be removed)
prosthesis
mastoiditis if present requires mastoidectomy
what can lead ot recurrences
if not all of it is removed
if underlying pathology that led to primary cholesteatoma (ET dysfunction, poor mastoid ventilation) is not corrected a well
Patients need to be counseled that surgery can cause complications depending on the size and location of the cholesteatoma, such as
Hearing loss (permanent – CHL, mixed, or SNHL)
Facial paralysis
Dizziness
Tinnitus
Intracranial complications such as
meningitis
intracranial absess
Recurrence of the cholesteatoma even after surgery
