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
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
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
See Also
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.
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.