Cholesteatoma
Epidemiology
Etiology
Pathophysiology
Warning
Cholesteatomas are collections of squamous cell debris that form a round, pearly mass. Despite what the name implies, cholesteatomas do not contain any lipid or cholesterol components.
Keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid air cells.
- Congenital cholesteatoma
- Acquired cholesteatoma (more common)
- Primary: eustachian tube dysfunction → tympanic membrane epithelium retracts inwards → retraction pocket
- Secondary: Epithelium migrates inwards through a perforation in the tympanic membrane, which is commonly caused by recurrent/chronic otitis media.
Clinical features
- Painless otorrhea (scant but foul-smelling discharge from the affected ear)
- Conductive hearing loss
Diagnostics
- Otoscopic findings:
- Primary acquired: retraction pocket with squamous epithelium and debris that often appears as a brown, irregular mass
- Congenital and secondary acquired: white or pearly mass behind the tympanic membrane