Cholesteatoma

Presented by:

Nader ALDAjani
Otologist, KFMC

Definition:

• Misnomer; neither contains cholesterol crystals nor is a tumor.
• Skin in the wrong place.

Pathophysiology:

• Squamous epithelium in the middle ear or mastoid.
• Desquamation leads to keratin debris accumulation.
• Associated with bone and soft tissue erosion and recurrent infections.

Types:

1. Acquired:

   • Primary: Due to invagination of a retraction pocket. - associated with negative ear pressure (eustachian tube dysfunction).
   • Secondary: Ingrowth of keratinizing epithelium into the middle ear space through a pre-existing TM perforation.

2. Congenital:

   • Presents as a white mass generally in the anterosuperior middle ear with an intact TM.

Presentation:

• Progressive conductive hearing loss (CHL), discharge. ((cholesteatoma can act as a sound conductor))
• OE: White “pearly” mass, perforation, discharge, polyps, destruction of attic area.
• Tests: CT, PTA, Tympanometry.

congenital if there are no perforations

Complications:

• Destruction of the ossicular chain.
• Chronic otitis media.
• Labyrinthine fistula.
• Intracranial complications.
• Facial nerve paralysis.

Management:

Antibiotics.

Surgery.

• Aim: to remove the disease, restore the function.
• Mastoidectomy.
• Reconstructive surgery.

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Tympanoplasty & Mastoidectomy

• Tympanoplasty: Surgical reconstruction of the tympanic membrane.

• Mastoidectomy: Surgical procedure to remove infected mastoid air cells.

http://www.ghorayeb.com/mastoidectomy.html