Cholesteatoma

Background

• Commonly secondary to Eustachian tube dysfunction, which retracts TM
• A retraction pocket forms and desquamating skin cells are trapped
  • Usually in "attic" involving pars flaccida
  • Their accumulation results in a slowly expanding mass
  • Sac of dead skin cells growing in middle ear on out of surface of TM
• Can destroy ossicles and expand into mastoid (rarely, intracranially causing brain abscess or meningitis)
• Often chronically infected with intermittent drainage

Clinical Features

• Conductive hearing loss
• May be associated with imbalance and facial weakness
• Retraction of TM around ossicles
• Formation of cholesteatoma that can retract into the attic of the middle ear

Differential Diagnosis

Ear Diagnoses

External

• Auricular hematoma
• Auricular perichondritis
• Cholesteatoma
• Contact dermatitis
• Ear foreign body
• Herpes zoster oticus (Ramsay Hunt syndrome)
• Malignant otitis externa
• Otitis externa
• Otomycosis
• Tympanic membrane rupture
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

Evaluation

• Clinical diagnosis
• Consider CT for examination of ossicle encasement

Management

• ENT referral

Disposition

• Outpatient, unless complicated intracranial process
• Many patients require second-look surgical procedure after first

References

• Schraff SA and Strasnick B. Pediatric cholesteatoma: A retrospective review. International Journal of Pediatric Otorhinolaryngology. Volume 70, Issue 3, March 2006, Pages 385-393.