II. Pathophysiology
- Benign squamous metaplasia of middle ear epithelium
- TM epithelium retracts into mastoid air cells
- Mass gradually expands and keratinizes
- Forms epithelial inclusion cyst
- Contains Cholesterol crystals and keratinous debris
- Results in destruction of middle Ear Ossicles
III. Cause
- Congenital Cholesteatoma
- Acquired Cholesteatoma
- Chronic or recurrent Otitis Media
- Tympanic Membrane Rupture
IV. Symptoms
-
Otalgia or Ear fullness
- Ear Pain is a late finding
- Headache
-
Hearing Loss
- Gradual onset
-
Otorrhea
- Chronic suppurative discharge from middle ear
- Via perforated Tympanic Membrane
V. Signs
- Middle ear Deafness
-
Otoscope Exam
- Pearly gray-white middle ear mass of debris behind the Tympanic Membrane
VI. Imaging
- Non-contrast CT of Temporal Bone
- Bony erosion and enlargement of middle ear
- Mastoid process with air cell opacification
VII. Management
- Surgical excision of Cholesteatoma
- Often with mastoidectomy, Ossicular Chain reconstruction
- Second look procedure may be scheduled at 6 months
VIII. Complications
- Conductive Hearing Loss
- Mastoiditis (most common cause)