Otology
Cholesteatoma
A destructive, skin-like cystic pathology of the middle ear — early diagnosis and mastoidectomy.
What is cholesteatoma and why is it dangerous?
Cholesteatoma is a skin-like (squamous epithelial) cystic growth in the middle ear or mastoid space. It is not cancer but is destructive: over time it can erode ossicles, the facial nerve, the inner ear, and even the skull base. The classic presentation is long-standing foul-smelling otorrhoea + conductive hearing loss. Risk of complications (facial palsy, sensorineural hearing loss, meningitis, intracranial abscess) justifies early surgery. Diagnosis is clinical (otoscopy/microscopy) + temporal-bone CT. Treatment is surgical: mastoidectomy (with tympanoplasty) is standard. Annual post-operative follow-up is essential — recurrence rate is 5–15%.
Surgical approach
Mastoidectomy types: canal-wall-up (CWU) and canal-wall-down (CWD). CWU: better anatomical preservation but higher recurrence (15–25%) — a second-look surgery 6–12 months later is recommended. CWD: lower recurrence (2–5%), but periodic cavity cleaning is needed.
Concurrent tympanoplasty (eardrum and ossicular reconstruction) addresses hearing loss. Stage 1: cholesteatoma clearance. Stage 2 (6–12 months later if needed): ossicular-chain reconstruction.
Frequently Asked Questions
- No. It is not cancer; however, its cellular behaviour is destructive — it erodes surrounding bone. That is why surgery is required.
- Otorrhoea lasting more than 6 weeks needs ENT evaluation. Microscopy + audiometry + temporal-bone CT (if needed) clarifies diagnosis.
- Hearing improves in most patients, but a full return to pre-disease normal cannot be guaranteed. Concurrent tympanoplasty + ossicular reconstruction aids the outcome.
- After CWD mastoidectomy, diving is contraindicated; flying is safe at 4 weeks. After CWU mastoidectomy + healthy tympanic membrane, 6–8 weeks before flying is advised.
- Paediatric cholesteatoma is more aggressive than adult; it spreads faster and recurs more often. Early surgery + annual follow-up are critical.
References
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