Cholesteatoma

Aetiology

The trapped squamous epithelium forms a sac with keratin debris
Chronic inflammation and infection ensue leading to:
 - growth and migration of the squamous epithelium
 - osteoclastic activity
 - causes PT tube dysfunction and oedema; providing a culture medium for bacteria

Can be congenital or acquired
- secondary to retraction of TM (primary acquired) 
- squamous epithelium migration during surgery e.g. grommet placement (secondary acquired)

History

• persistent or recurrent purulent otorrhoea
• hearing loss
• tinnitus
• rarely: vertigo, ataxia, facial nerve paresis (from invasion)

Hallmark symptom is painless otorrhoea

Examination

Can examine in a number of ways e.g. with a slight retraction
or hidden by copious discharge

Always suspect cholesteatoma in patients who do not respond to treatment for presumed "otitis externa"

Investigations

CT scan
Audiometry
MRI if facial nerve, labyrinth or intracranial involvement suspected

Management

The mainstay of treatment is surgical - mastoidectomy and the extent of the operation will depend on the location of the cholesteatoma 

Medical adjunctive therapy:

• microscopic removal of debris from EAC
• keep all water out of ears - prevent contamination
• topical antibiotics