Cholesteatoma

Growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process; non-cancerous but destructive and expanding

Aetiology

• Common, can occur in any age group

• Can be aquired or congenital
• Acquired (most common) - caused by chronic otitis media or perforated tympanic membrane
• Congenital - proliferation of embryonic rest

• History of frequent ear surgery is a key risk factor

Pathophysiology

• The keratin becomes trapped and builds

• As it expands, it erodes surrounding bone

Histology

• Squamous epithelium with abundant keratin production, associated inflammation

Clinical presentation

• May be asymptomatic in its early stages

• Unilateral discharge - persistent or recurrent discharge, often foul-smelling

• Associated conductive hearing loss may also occur

• Rarely with progression of the disease, vertigo, sensorineural hearing loss, facial nerve palsy, meningitis, or intracranial abscess may develop

Investigations

Otoscopy

• Retraction visible before development of cholesteatoma

• Examination show a defect in the tympanic membrane full of cheesy, white material

Management

• Mastoid surgery to remove the sac of debris, reconstruction