Cholesteatoma

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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

  • Retraction of TM around ossicles
  • Formation of cholesteatoma that can retract into the attic of the middle ear

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

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.

Authors:

Kevin Lu