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Cholesteatoma

This is a rare complication of chronic otitis media, where there’s an abnormal accumulation of squamous epithelial cells in the middle ear


N.B. It's a non-cancerous/benign mass.


It presents with:

  • Foul-smelling discharge

  • HL (conductive)

  • Otalgia

  • Headache

  • O/E - White debris/crust near the top, behind the tympanic membrane

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“The large mass of white keratin debris in the left upper quadrant of this left tympanic membrane is a cholesteatoma. The majority of the tympanic membrane is missing [perforation]. In the lower right quadrant the round window niche on the medial wall middleware can be seen.” © Michael Hawke MD CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

N.B. Like otitis media, it can invade local tissues, leading to facial nerve palsy or CNS complications.


Investigations:

  • Audiology

  • CT Head to confirm

  • MRI to assess invasion and local tissue damage


Management - Surgery





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