Patient will present as→ a 43-year-old male with a “lifelong” history of chronic ear infections and episodic purulent drainage from his right ear canal. The patient currently is without symptoms. Examination of the ear shows a clear external canal, but the tympanic membrane is retracted and there is a pocket of white material and an opacity of the pars flaccida. The Weber test lateralizes to the right and Rinne shows air conduction > bone conduction on the left and bone conduction > air conduction on the right. Preparations are made to undergo a non-contrast computed tomography (CT) scan of the temporal bone.
Cholesteatoma is an abnormal growth of skin in the middle ear behind the eardrum.
- Commonly occurs as a complication of recurring ear infections and by chronic eustachian tube dysfunction which results in chronic negative pressure which inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss.
- Pt will present with painless otorrhea (brown/yellow discharge with strong odor) it may not be bothersome to the patient.
- May also present with hearing loss, tinnitus, dizziness, otorrhea, and cranial nerve palsies.
Diagnosis can be made with otoscopic visualization of granulation tissue
- Confirm with CT scan and audiogram to evaluate hearing loss
Management of cholesteatoma includes surgical excision of the debris/cholesteatoma and reconstruction of the ossicles
Question 1 |
Oral antibiotics | |
Antibiotic otic drops | |
Oral steroids | |
Tympanostomy tube placement | |
Surgical removal |
References: UpToDate
