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Snapshot
  • A 27-year-old man presents to his primary care physician for the evaluation of ear discharge of the right ear. He also reports mild hearing loss on the affected ear with occasional episodes of tinnitus. Medical history is significant for 3 episodes of otitis media treated with antibiotics. On physical exam, there is amorphous, white debris in the right middle ear.
Introduction
  • Clinical definition
    • a collection of keratinized squamous epithelium in the middle ear or mastoid
  • Epidemiology
    • incidence
      • unknown
    • demographics
      • acquired cases occur in children and adults
      • congenital cases begin in childhood
    • location
      • soft tissue and bony structures of the temporal bone
    • risk factors
      • family history
      • long-standing Eustachian tube dysfunction
      • cleft palate and other craniofacial anomalies
  • Pathophysiology
    • pathoanatomy
      • prolonged middle ear negative pressure may retract the tympanic membrane which can
        • create a pocket where keritinized squamous debris accumulate
      • perforation of the tympanic membrane may lead to
        • squamous epithelium migration to the middle ear resulting in squamous debris accumulation
  • Prognosis
    • there may be recurrence of cholesteatoma post-surgery
Presentation
  • Symptoms
    • can be asymptomatic
    • hearing loss
      • can occasionally occur with tinnitus
    • dizziness
    • otorrhea
  • Physical exam
    • may have tympanic perforation
      • except in congenital cases
    • mucopus and granulation tissue on otoscopic examination
Imaging
  • Computed tomography (CT) scan
    • indications
      • if there is suspicion for extracranial complications and to make preparations for surgical removal
Studies
  • Clinical diagnosis
Differential
  • Bulging acute otitis media
  • Otitis externa
  • Tympanosclerosis
Treatment
  • Operative
    • mastoidectomy
      • indication
        • treatment of choice in most patients with cholesteatoma
Complications
  • Hearing loss
  • Acute mastoiditis
  • Brain abscess
  • Subperiosteal abscess
 

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