Cholesteatoma
Cholesteatoma is an abnormal growth of keratinizing squamous epithelium in the middle ear that erodes the ossicles, mastoid, and adjacent skull base; it is confirmed on otoscopy, staged by CT, and requires mastoidectomy with tympanoplasty because no medical therapy is curative.
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What this article covers
- Overview
Definition: cholesteatoma is an abnormal growth of keratinized, stratified squamous epithelium ("skin in the wrong place") within the middle ear and mastoid that behaves as a locally destructive…
- Epidemiology
Acquired cholesteatoma is far more common than congenital disease and typically presents in patients with a history of recurrent or chronic middle-ear disease; it can present at any age but is…
- Risk factors
Eustachian tube dysfunction: the dominant driver of primary acquired disease, producing chronic negative middle-ear pressure that draws the tympanic membrane inward.
- Pathophysiology
Primary acquired cholesteatoma begins with eustachian tube dysfunction, which creates sustained negative middle-ear pressure that pulls the pars flaccida (or posterosuperior pars tensa) inward…
- Clinical features
Painless otorrhea is the classic presenting symptom: chronic or intermittent, often malodorous, ear drainage that is characteristically NOT painful, unlike the pain-predominant presentation of acute otitis media or otitis externa.
- Differential diagnosis
Chronic suppurative otitis media: chronic otorrhea through a perforation, but without the pearly white retraction-pocket mass; frequently coexists and must be excluded whenever drainage persists despite therapy.
- Diagnosis
Cholesteatoma is confirmed by otoscopic examination: the clinching finding is a retraction pocket (classically pars flaccida/attic, or posterosuperior pars tensa) containing a pearly white…
- Management
Definitive treatment is surgical excision; no medical therapy is curative.
- Complications
Facial nerve palsy: erosion of the facial nerve canal (the nerve courses directly through the middle ear/mastoid) can produce facial weakness; a surgical urgency because delayed decompression worsens the chance of recovery.
- Prognosis
Excellent when the disease is confined to the middle ear/mastoid and completely excised: surgical removal halts the destructive process and prevents further bone erosion.
- Prevention
Otorrhea persisting despite a completed antibiotic course warrants otolaryngology referral for otoscopy rather than another antibiotic course, since persistent drainage on treatment signals a…
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Related articles
- Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.
- Mastoiditis
Acute mastoiditis is a suppurative infection of the mastoid air cells, almost always arising as an extension of untreated or inadequately treated acute otitis media. It is diagnosed clinically by postauricular erythema, tenderness, and swelling with the auricle displaced anteriorly, and is treated with intravenous antibiotics escalating to myringotomy or mastoidectomy when abscess or complications are present.
- Acute otitis media
Acute otitis media is a suppurative middle ear infection, mostly in young children, diagnosed by otoscopy showing a bulging, erythematous tympanic membrane with an effusion, and it is treated with observation or amoxicillin depending on age and severity.
- Otitis media with effusion
Otitis media with effusion is middle-ear fluid persisting without signs of acute infection, most often in young children after an upper respiratory infection or acute otitis media, managed mainly with observation and reserving tympanostomy tubes for persistent hearing loss.