Cholesteatoma

Question 1

Cholesteatoma is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. What is the incidence of this condition?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

Answer 1

2 - 10 cases per 100,000

Suspected that the growth of squamous epithelium block areas and secrete enzymes that can degrade tissues such as bone

Question 2

Cholesteatoma is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. What age group is this most common in?

1 - 1-5y
2 - 5-10
3 - 10-20
4 - 20-40

Answer 2

3 - 10-20

Equally affects males and females

Question 3

Although the exact cause of cholesteatoma remains unknown, is it suspected that there are more acquired or congenital causes?

Answer 3

• 95% are suspected to be acquired

Suspected that the growth of squamous epithelium block areas and secrete enzymes that can degrade tissues such as bone

Being born with a cleft lip is a big risk factor though

Question 4

Around 95% of cases of cholesteatoma are suspected to be acquired. What has been linked with causing the majority of cases of this?

1 - recurrent infection
2 - pocket of retraction
3 - breast feeding
4 - trauma

Answer 4

2 - pocket of retraction

Typically in the pars flaccid

Question 5

All of the following are presentations of cholesteatoma, but which 2 are typically the 1st symptoms patients present with?

1 - foul smelling otorrhea (discharge)
2 - facial weakness
3 - vertigo
4 - tinnitus
5 - hearing loss

Answer 5

1 - foul smelling otorrhea (discharge)
5 - hearing loss

Other symptoms occur as the condition progresses

Question 6

In cholesteatoma what are we UNLIKELY to see at the tympanic membrane of a patient with cholesteatoma?

1 - perforation
2 - pocket of retraction
3 - hemotympanum
4 - keratin granulation tissue
5 - ossicular erosion

Answer 6

3 - hemotympanum

Blood in the ear

In congenital cholesteatoma, tympanic membrane is intact and may see pearly white mass behind typanic membrane

Question 7

Are patients with cholesteatoma more likely to have conductive or sensorineural hearing loss?

Answer 7

• conductive

They will have an audiogram to confirm this

If it spreads, it could move to the inner ear

Question 8

What imaging is typically 1st line in cholesteatoma?

1 - ultrasound head
2 - MRI head
3 - CT head
4 - PET scan

Answer 8

3 - CT head

MRI diffuse weighted imaging (DWI) will be done if needed to help guide surgery

Question 9

Do all patients with cholesteatoma have surgery as soon as possible?

Answer 9

• no

Patients managed conservatively 1st with antibiotics

Surgery options:

+/- repair of tympanic membrane
+/- reconstruction of ossicular chain

Followed for at least 5 years following surgery