ME Disorders (Cholesteatoma)

Question 1

what is a cholesteatoma

Answer 1

“pseudotumors” that can occupy the external ear canal, ME cavity, or extend through the mastoid bone into the brain cavity

Question 2

how do cholesteatoma manifest

Answer 2

manifest highly aggressive, progressively enlarging, tumor-like characteristics

Question 3

how do they manifest/fxn like a tumor

Answer 3

They are highly erosive and may cause destruction of bone and other tissue
Recently, highly invasive fibroblasts were found in cholesteatoma that are not seen in normal skin, which may explain the aggressive behavior of a cholesteatoma

Question 4

Cholesteatoma can be

Answer 4

congenital or acquired

Question 5

what is a congenital cholesteatoma

Answer 5

Almost always present in children
Median age is ~ 5 years
3:1 male to female ratio
The TM can be normal without a history of perforation, otorrhea, or myringotomy
Most common location is the anterior-superior quadrant
Etiology is controversial

Question 6

what are acquired cholesteotoma

Answer 6

More common than congenital
Often due to chronic or untreated otitis media with effusion or trauma leading to TM perforation
Also occurs as a result of TM retraction in the pars flaccida or posterior-superior quadrant
Previous ear surgery/TM perforation also may be the growth site
Slow growing condition, initially with no symptoms
Usually presents first with a hearing loss

Question 7

what are iatrogenic cholesteatomas

Answer 7

May result because of a blunt knife used during myringotomy
May lead to implantation of squamous epithelium in ME cavity

Question 8

how do chol grow

Answer 8

by forming a keratinized epithelial layer and a fibrous subepithelial layer called a matrix

Question 9

What forms a keratoma

Answer 9

Keratin (dead skin cells and debris) builds up and gets covered by cells

Question 10

what does a keratoma do

Answer 10

evoke inflammatory reaction leading to formation of a cholesteatoma, mostly in the attic area of the ME cavity

Question 11

how does cholesteatoma result in mastoiditis

Answer 11

they will grow, engulf, and erode the ossicles, bones of the tympanic cavity

Question 12

A cholesteatoma can become

Answer 12

secondarily infected producing otorrhea (foul smelling discharge)

Question 13

iatrogenic

Answer 13

something related to surgery procedures

Question 14

if large enough, can exert pressure on CN VII causing

Answer 14

causing facial palsy

Question 15

what type of tymp would you see with cholesteatomas

Answer 15

depends on size, location & how much it has damaged

Question 16

normal tymp

Answer 16

no damage

Question 17

type as

Answer 17

cholesteatoma is filling the ME cavity; a stiffness dominated system

Question 18

type ad

Answer 18

If ossicular disarticulation has occurred t

Question 19

type b flat with low volume

Answer 19

If it has caused TM peroration and is filling up the ME cavity

Question 20

type b high volume

Answer 20

If the cholesteatoma is not big enough to fill up the ME cavity and TM perforation is present

Question 21

Auditory sensitivity varies depending on

Answer 21

underlying damage

Question 22

Hearing is normal

Answer 22

if the ossicular chain is intact and the cholesteatoma only caused TM perforation or no perforatio

Question 23

chl

Answer 23

f ossicular disarticulation occurred

Question 24

Mixed hearing loss

Answer 24

if goes into the inner ear

Question 25

what are PT complaints of cholesteatoma

Answer 25

Foul smelling discharge and often bleeding
Hearing loss verified by an audiologic evaluation
Otalgia, headache, or occasionally mild dizziness

Question 26

is diagnosis difficult of cholesteatoma

Answer 26

Usually diagnosis is not difficult because it can be visualized on a microscopic exam of the ear in the physician’s office

Question 27

why ct scan is done

Answer 27

To identify potential damage caused by the cholesteatoma, including facial nerve dehiscence and ossicular damage, for better patient counseling
But many otologists do not order a CT scan because it does not change the management

Question 28

what is the primary treatment

Answer 28

surgical removal

Question 29

why do they not like bleeding into the surgical site

Answer 29

makes it harder to see

Question 30

why are antibiotic steroid drops prescribed prior to surgery

Answer 30

decrease inflammation and granulation tissue, which decreases bleeding during surgery

Question 31

surgery can result in

Answer 31

HL (tm and ossicles may be removed)
prosthesis
mastoiditis if present requires mastoidectomy

Question 32

what can lead ot recurrences

Answer 32

if not all of it is removed
if underlying pathology that led to primary cholesteatoma (ET dysfunction, poor mastoid ventilation) is not corrected a well

Question 33

Patients need to be counseled that surgery can cause complications depending on the size and location of the cholesteatoma, such as

Answer 33

Hearing loss (permanent – CHL, mixed, or SNHL)

Facial paralysis

Dizziness

Tinnitus

Intracranial complications such as
meningitis
intracranial absess

Recurrence of the cholesteatoma even after surgery