© Bruce Black MD

CHOLESTEATOMA A Brief Overview

© Bruce Black MD

DEFINITION A Sac/Cyst of Skin in the Ear

Not a neoplasm Frequently silent onset Capable of major complications

© Bruce Black MD

CHOLESTEATOMA Classification

Congenital Acquired

Attic Pars tensa Combined Attic-Pars tensa

© Bruce Black MD

Acquired cholesteatoma is the end Stage IV of adhesive otitis, where the drum collapse has invaginated into the

middle ear cleft, accumulating keratin debris. © Bruce Black MD

Right Congenital cholesteatoma. Classic spherical “pearl”: a cyst of skin identical to external canal skin.

© Bruce Black MD

Attic cholesteatoma is an invagination of canal skin via the pars flaccida, forming a sac within the middle ear cleft.

© Bruce Black MD

Pars tensa cholesteatoma. Typical retraction pocket filled with silvery keratin extending superiorly into the attic.

Severely tympanosclerotic remaining pars tensa. © Bruce Black MD

Combined attic-drum collapse pattern cholesteatoma.

© Bruce Black MD

When infected, cholesteatoma has a foul discharge , which may be blood-stained if accompanied by an aural polyp

formation. © Bruce Black MD

A conductive deafness is usually present, in this case accompanied by Type B tympanograms indicative of

accompanying middle ear effusions. © Bruce Black MD

Complications of medial spread of cholesteatoma. 1. Conductive loss. 2. Facial palsy. 3. Fistula and bacterial

labyrinthitis (SN deafness, tinnitus, vertigo). © Bruce Black MD

Complications of posterior cholesteatoma extension. 1. Acute mastoiditis. 2. Lateral sinus thrombosis, disseminated

abscesses, otitic hydrocephalus. 3. cerebellar abscess.

© Bruce Black MD

Complications of superior extension of cholesteatoma. 1. Extradural middle fossa abscess. 2. Meningitis. 3. Subdural

abscess. 4. Cerebritis. 5. Temporal lobe abscess. © Bruce Black MD

Rt. Facial paresis secondary to cholesteatomatous otitis media.

© Bruce Black MD

Acute mastoiditis in a child, secondary to active attic cholesteatoma. Typical fluctuant subperiosteal abscess

overlying the superficial air cells postero-superior to the ear. © Bruce Black MD

Otitic hydrocephalus secondary to past cholesteatoma, retrograde sigmoid sinus thrombosis, meningitis and

profound sensorineural deafness. © Bruce Black MD

Axial CT scan showing marked cerebritis and cerebral abscess formation subsequent to chronic

cholesteatomatous otitis media. © Bruce Black MD

Because of the risk of complications, microsurgery is mandatory in many cases.

© Bruce Black MD

A major problem with surgery is a tendency for disease to persist as minute rests of residual cholesteatoma, or to

reform sacs. © Bruce Black MD

Reforming drum collapse after cholesteatoma surgery. Precise repairs are essential to prevent this complication.

© Bruce Black MD

To prevent recurrent sac formation the drum and canal wall are repaired with cartilage composite grafts.

© Bruce Black MD

SUMMARY

A commonly covert disease Beware bloodstained or foul

otorrhoea Beware granulations or polyps in

the EAC Refer for specialist care if

suspected © Bruce Black MD