Fact-sheet: Cholesteatoma
Updated on 09/17/2021 at 12:16 PM
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Definition
Chronic cholesteatomatous otitis media is considered dangerous because of the osteolytic properties and progressive nature of cholesteatoma, which is a potential source of serious complications.
It is characterized by the presence of keratinizing squamous epithelium within the middle ear cavity.
It accounts for approximately one-third of chronic suppurative otitis cases.
It can occur at any age.
It can be bilateral in 10% of cases
Clinical features
Clinical signs:
-foul-smelling otorrhea
-otorrhagia or hearing loss
-may be revealed by complications such as otalgia, vertigo, facial nerve palsy, meningitis, or abcess of brain, thrombophlebitis, cutaneous fistulization
Visualization of a whitish mass on otoscopic examination (epidermal squame) within a tympanic retraction pocket (classically at the pars flaccida of the tympanic membrane)
CT
Isodense mass filling the attic or occasionally the entire middle ear, associated with bone erosion (+/- ossicular chain++)
MRI
-iso- to hypointense on T1-weighted sequences
-hyperintense on T2
-no enhancement after gadolinium administration, even on delayed imaging. Thin peripheral enhancement may be seen related to perilesional inflammation
- Diffusion: marked hyperintensity on single-shot TSE and diffusion gradient between b0 and b800 on EPI
Management
Systematic surgical treatment, a "second look" procedure is often necessary