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Updated: Dec 17 2021


  • 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
    • 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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