II. Pathophysiology

  1. Benign squamous metaplasia of middle ear epithelium
    1. TM epithelium retracts into mastoid air cells
    2. Mass gradually expands and keratinizes
    3. Forms epithelial inclusion cyst
    4. Contains Cholesterol crystals and keratinous debris
  2. Results in destruction of middle Ear Ossicles
    1. Conductive Hearing Loss

III. Cause

  1. Congenital Cholesteatoma
  2. Acquired Cholesteatoma
    1. Chronic or recurrent Otitis Media
    2. Tympanic Membrane Rupture

IV. Symptoms

  1. Otalgia or Ear fullness
    1. Ear Pain is a late finding
  2. Headache
  3. Hearing Loss
    1. Gradual onset
  4. Otorrhea
    1. Chronic suppurative discharge from middle ear
    2. Via perforated Tympanic Membrane

V. Signs

  1. Middle ear Deafness
  2. Otoscope Exam
    1. Pearly gray-white middle ear mass of debris behind the Tympanic Membrane

VI. Imaging

  1. Non-contrast CT of Temporal Bone
    1. Bony erosion and enlargement of middle ear
    2. Mastoid process with air cell opacification

VII. Management

  1. Surgical excision of Cholesteatoma
    1. Often with mastoidectomy, Ossicular Chain reconstruction
  2. Second look procedure may be scheduled at 6 months

VIII. Complications

  1. Conductive Hearing Loss
  2. Mastoiditis (most common cause)

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