Cholesteatoma

Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid.

Although benign, it may enlarge and invade adjacent bone.

Often presents with a malodorous ear discharge with associated hearing loss.

Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent.

Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively.

Complications include hearing loss, recurrence, meningitis, facial palsy, and a labyrinthine fistula.

Cholesteatoma is defined as the presence of keratinising squamous epithelium within the middle ear, or in other pneumatised areas of the temporal bone. This keratinising epithelium exhibits independent growth, leading to expansion and to resorption of underlying bone.[1]Kuo CL, Shiao AS, Yung M, et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int. 2015;2015:854024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381684 http://www.ncbi.nlm.nih.gov/pubmed/25866816?tool=bestpractice.com ​ Focal erosion of external canal bone with accumulation of keratin is called external canal cholesteatoma.[2]Ho KY, Huang TY, Tsai SM, et al. Surgical treatment of external auditory canal cholesteatoma - ten years of clinical experience. J Int Adv Otol. 2017 Apr;13(1):9-13. https://pdfs.semanticscholar.org/1999/444c7613f6fa07a8fcd885604d533cc3476d.pdf http://www.ncbi.nlm.nih.gov/pubmed/28274897?tool=bestpractice.com ​​