EAR - Cholesteatoma

What is cholesteatoma?

Cholesteatoma is the presence of squamous epithelial pocket or sac, filled with keratin debris within the middle ear cleft. It is a cause of unsafe chronic suppurative otitis media. It can cause dangerous life threatening complications.

What are the different types of cholesteatoma?

Cholesteatoma is divided into 3 types:

  1. Congenital Cholesteatoma
  2. Primary Acquired Cholesteatoma
  3. Secondary Acquired Cholesteatoma

What investigations are required for congenital cholesteatoma?

X-ray mastoid Schuller's view shows bone erosion, High Resolution CT Scan shows severe involvement and erosion of the temporal bone along with the status of the ossicular chain..

What is primary acquired cholesteatoma?

This develops in continuity with pars flaccida of the tympanic membrane.

What is secondary acquired cholesteatoma?

This develops with ingrowth of squamous epithelium from the pars tensa in marginal or postero-superior perforation.

What are the signs and symptoms of cholesteatoma?

  1. Ear discharge (Otorrhoea): The discharge is scanty, foul smelling, continuous and yellowish or greenish.
  2. Deafness: There is moderate to severe hearing loss. It may be conductive or mixed.
  3. Ear pain
  4. Ringing sensation in the ear(Tinnitus)
  5. Vertigo
  6. Patients may also present with intracranial, or extracranial complications of unsafe CSOM (chronic suppurative otitis media)

What investigations are required to confirm the diagnosis of cholesteatoma?

  1. Routine blood count, X-ray chest, ECG.
  2. Otomicroscopy: For suction of discharge and confirm clinical findings.
  3. Pure tone audiometry: It is a qualitative and quantitative analysis of the patients hearing.
  4. Ear swab: For discharge, culture and antibiotic sensitivity.
  5. High Resolution CT Scan shows severe involvement and erosion of the temporal bone along with the status of the ossicular chain..

What is the treatment of cholesteatoma?

Surgery is the only treatment for cholesteatoma.It is called mastoidectomy.The surgery depends on the extent of the disease spread.
The Medical line of treatment may be useful to control the rapid spread of infection.


Depending on the extent of and severity of the discharge, a Modified Radical or Radial Mastoidectomy is indicated.

Aims of Surgery:

  1. Make the ear safe and prevent complications
  2. Make the ear dry
  3. Restore maximum possible hearing

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