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W21 - 9530 > Week 4 - Cholesteatoma > Flashcards

Week 4 - Cholesteatoma Flashcards

1
Q

What is a cholesteatoma?

A

ME mass described as a cyst or tumour (noncancerous)

- epidermal inclusion cyst formed from stratified squamous epithelium

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2
Q

If cholesteatomas are non-cancerous, what’s the danger?

A

They can erode ossicles and spread to invade and damage surrounding tissues

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3
Q

What are the 2 classifications of cholesteatomas?

A
  1. Acquired (Primary or Secondary)

2. Congenital

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4
Q

What is a congenital cholesteatoma composed of?

A

Residual embryonic cells trapped in the ME

  • squamous epithelial cells that produce keratin
  • appears as a white mass medial to normal TM in ME cavity
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5
Q

What is the prognosis of congenital cholesteatoma dependent on?

A

Intact TM and no other otological issues

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6
Q

What two things can an acquired cholesteatoma develop from?

A

TM retraction or TM perforation

  • allow skin and other debris to enter ME
  • usually present with hx of poor ET function and chronic OM
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7
Q

What does the cyst-like pouch of an acquired cholesteatoma consist of?

A
  • Dead and viable squamous epithelial cells
  • Keratin shed by viable cells
  • Enzymes that erode bone
  • Cholesterol crystals
  • Bacteria
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8
Q

Describe the two types of acquired cholesteatoma

A

Primary - TM retraction that accumulates epithelium and debris

Secondary - Result of migration of epithelium and debris through a perforation in the TM

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9
Q

What is otorrhea?

A

Ear drainage/discharge

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10
Q

T/F: A primary acquired cholesteatoma will always remain attached at the point of origin

A

False: It can eventually pinch off and continue to grow, forming a true cholesteatoma

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11
Q

What are 2 common sites for an acquired cholesteatoma to originate and which part of the ME do they move into?

A

Pars flaccida into posterior and anterior epitympanum (superior region of ME)

Posterior pars teens into mesotympanum

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12
Q

What are some of the complications caused by cholesteatomas?

A
  • ME - erosion of ossicles and walls
  • Posterior extension into the mastoid
  • Superior invasion into brain cavity causing meningitis & abscess
  • Medial wall - erosion of bony labyrinth causing sudden vertigo or sudden SNHL
  • inferior - complication with facial nerve
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13
Q

What symptoms during a case hx might indicate cholesteatoma?

A
  • fullness or pressure in the ear
  • hearing loss
  • otorrhea (drainage, possibly malodorous)
  • otalgia (pain behind/in ear)
  • dizziness or vertigo
  • muscle weakness on one side of the face
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14
Q

What might a cholesteatoma show up as during a routine ax?

A

Audiometry: normal, conductive or mixed HL

Immitance: vary from normal to abnormal

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15
Q

How are cholesteatomas managed (from our perspective)?

A

Amplification

Aural rehabilitation

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16
Q

How are cholesteatomas managed in general?

A
  • Possibly start by cleaning the ear (debridement) and antibiotics (goal to reduce pain, stop drainage, and control infection)
  • Surgery to protect the patient from serious complications (goal to preserve or restore facial function and hearing)
17
Q

Cholesteatoma surgery might be 1- or 2-steps. What might the follow-up revision be for with a 2-step surgery?

A
  1. Reconstruction to rebuild the walls of the ME or canal, reduce size of mastoid cavity, facial nerve repair, ossicular repair/replacement
  2. Removal of recurrence of cholesteatoma
18
Q

Cholesteatoma surgery varies with the extent of the disease and degree of pre-operative HL. What are two approaches?

A

Tympanoplasty

  • removal of cholesteatoma through TM
  • rare, d/t the aggressive nature of the cholesteatoma

Mastoidectomy
- mastoid bone explored to remove any cholesteatoma that involves the bone and ME

19
Q

What are the 2 basic types of Mastoidectomy?

A
  1. Canal-wall-up (CWU)
    - posterior wall of external canal intact
    - no mastoid cavity requiring cleaning, but higher risk of recurrence
  2. Canal-wall-down (CWD)
    - removal of bony partition b/w external canal and mastoid
    - more extensive
20
Q

What is a Canal Wall Down Modified Radical Mastoidectomy?

A
  • less extensive and most common
  • ME cavity left intact
  • TM and/or ossicles retained or repaired
  • variable degree of post-op conductive or mixed HL
21
Q

What are some of the disadvantages of a Canal Wall Down Mastoidectomy?

A
  • larger than normal canal opening and large open cavity (mastoid bowl)
  • accumulation of debris in exteriorized mastoid cavity -> see doctor several times a year for cleaning
  • Plugs when swimming, and vertigo in cold or hot water
  • Chronic otorrhea resistant to tx
  • hearing problems
22
Q

Patients with no residual hearing and an ear that cannot be kept dry may have a Canal Wall Down Radical Mastoidectomy. What is removed in this surgery?

A
  • extensive removal of bony structures, so ME, canal and mastoid cavity form single space
  • TM and ossicles removed
  • total exteriorization of ME, attic, and mastoid cavity and obliteration of ET
  • Conductive/Mixed HL with max conductive component
23
Q

What are some of the problems with amplification after a mastoidectomy, and what are some solutions?

A

Problems:

  • large post-operative meatus -> altered resonance frequency
  • inadequate aeration d/t occlusion

Alternatives:

  • Bone conduction aids
  • Reconstruction of mastoid cavity and EAM to reduce size and improve function
  • high rate of dry ears and HL remains

W21 - 9530 (6 decks)

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