Updated: 12/17/2021

Cholesteatoma

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  • Snapshot
    • A 29-year-old man presents with unresolved left ear pain for the past 5 months. He also states to having a relative hearing loss of the left ear with occasional tinnitus. Medical history is significant for otitis media that was treated with appropriate antibiotics. He reports completing the course of antibiotics. On physical examination, there is an amorphous, white debri in the left middle ear. Preparations are made to undergo a non-contrast computer tomography (CT) scan of the temporal bone.
  • Introduction
    • Overview
      • a collection of keratinized squamous epithelium in the middle ear or mastoid
  • Epidemiology
    • Incidence
      • unknown
    • Demographics
      • acquired cases occur in children and adults
      • congenital cases begin in childhood
    • Location
      • soft tissue and bony structures of the temporal bone
    • Risk factors
      • family history
      • long-standing Eustachian tube dysfunction
      • cleft palate and other craniofacial anomalies
  • ETIOLOGY
    • Pathophysiology
      • pathoanatomy
        • prolonged middle ear negative pressure may retract the tympanic membrane which can
          • create a pocket where keritinized squamous debri accumulate
        • perforation of the tympanic membrane may lead to
          • squamous epithelium migration to the middle ear resulting in squamous debri accumulation
  • Presentation
    • Symptoms
      • can be asymptomatic
      • hearing loss
        • can occasionally occur with tinnitus
      • dizziness
      • otorrhea
      • cranial nerve palsies
    • Physical exam
      • may have tympanic perforation
        • except in congenital cases
      • mucopus and granulation tissue on otoscopic examination
  • Imaging
    • Computed tomography (CT) scan
      • indications
        • if there is suspicion for extracranial complications and to make preparations for surgical removal
  • Studies
    • Clinical diagnosis
  • Differential
    • Bulging acute otitis media
    • Otitis externa
    • Tympanosclerosis
  • Treatment
    • Operative
      • mastoidectomy
        • indication
          • treatment of choice in most patients with cholesteatoma
  • Complications
    • Hearing loss
    • Acute mastoiditis
    • Brain abscess
    • Subperiosteal abscess
  • Prognosis
    • There may be recurrence of cholesteatoma post-surgery
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(M2.ET.17.4817) A 42-year old female comes to the emergency room complaining of facial droop. She reports that she first noticed the facial droop this morning while she had been getting ready for work. Her smile appeared asymmetric and she could not fully close her left eye. A review of systems is also significant for one month of foul otorrhea. The patient’s medical history is significant for recurrent childhood ear infections. The patient’s temperature is 99.0°F (37.2°C), blood pressure is 110/65 mmHg, pulse is 72/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. On physical exam, the patient’s mouth is drooping downward on the left, and the patient cannot fully close her left eye. She also has drainage from the left ear, and otoscopic examination demonstrates the finding seen in Figure A. An audiometric evaluation reveals conductive hearing loss in the left ear. Which of the following is the most likely explanation for these findings?

QID: 109378
FIGURES:

Acute otitis externa

2%

(1/45)

Cholesteatoma

76%

(34/45)

Foreign body

2%

(1/45)

Schwannoma

9%

(4/45)

Tympanosclerosis

9%

(4/45)

M 6 C

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