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Cholesteatoma
Aka: Cholesteatoma
- Pathophysiology
- Benign squamous metaplasia of middle ear epithelium
- TM epithelium retracts into mastoid air cells
- Mass gradually expands and keratinizes
- Forms epithelial inclusion cyst
- Contains Cholesterol crystals and keratinous debris
- Results in destruction of middle Ear Ossicles
- Conductive Hearing Loss
- Cause
- Congenital Cholesteatoma
- Acquired Cholesteatoma
- Chronic or recurrent Otitis Media
- Tympanic Membrane Rupture
- Symptoms
- Otalgia or Ear fullness
- Ear Pain is a late finding
- Headache
- Hearing Loss
- Gradual onset
- Otorrhea
- Chronic suppurative discharge from middle ear
- Via perforated Tympanic Membrane
- Signs
- Middle ear Deafness
- Otoscope Exam
- Pearly gray-white middle ear mass of debris behind the Tympanic Membrane
- Imaging
- Non-contrast CT of Temporal Bone
- Bony erosion and enlargement of middle ear
- Mastoid process with air cell opacification
- Management
- Surgical excision of Cholesteatoma
- Often with mastoidectomy, Ossicular Chain reconstruction
- Second look procedure may be scheduled at 6 months
- Complications
- Conductive Hearing Loss
- Mastoiditis (most common cause)
- References
- Michels (2019) Am Fam Physician 100(2): 98-108 [PubMed]