Cholesteatoma

Marissa Swanson

Cholesteatoma

What is a cholesteatoma?

• Benign

• Overproduction of squamous keratinized epithelium in the middle ear.

• Congenital OR Acquired

• Effects on the auditory system:
• drainage
• conductive hearing loss
• pain
• dizziness and vertigo

• Complications arise due to location and size, potentially invading the CNS.

Middle ear cholesteatoma

• 4 main theories as to why cholesteatomas develop...

• The main theories are:
• chronic ME infections
• chronically retracted tympanic membrane

External auditory canal cholesteatoma

• commonly appears after surgery or trauma

• Higher incidence in those with stenotic canals

(Thoompson, 2017)

post-suction

pre-suction

An 80-year-old Caucasian man presented with an incidental and asymptomatic lesion in his right ear thought to be secondary to his use of hearing aids for presbycusis. He used Lyric hearing aids, designed for 24 hours-a-day use for 4 months at a time and had no other previous otological problems.

Lyric hearing aid: a rare cause of benign necrotising otitis externa/external ear canal cholesteatoma

Type B tympanogram; reduced static admittance

CT scan, coronal view

Same patient. 1 year apart

• Audiometry
• CT
• MRI

• Otoscopy
• Tympanometry
• Acoustic reflexes

Diagnosing a cholesteatoma

Surgical Management

• Canal wall up (CWU)
• leaves ear canal intact
• Canal wall Down (CWD)
• technique if tumor is larger and grown into the canal
• less recurrence with this method
• ossicles are removed
• part of mastoid removed
• radical mastoidectomy
• A "second look" procedure is often preformed to ensure all abnormal tissue has been removed

Structures examined are: epitympanum/mesotympanum/hypotympanum, sinus tympani, facial recess, anterior epitympanum recess, ossicles, mastoid air cells, and the IAC.

On tympanic membrane

EAC cholesteatoma

invasion of mastoid bone

High Resolution CT Scan

• Gold standard for diagnosing a cholesteatoma
• Detected by the presence of bony erosion of the ossicles and tympanic membrane

• Differential Diagnosis:
• Otitis Media (if there is no bony erosion seen on CT)

• MRI is the gold standard for the detection of cholesteatoma regrowth after surgical removal.
• MRI with T2 weighting is recommended.
• A cholesteatoma will appear hypointense (dark grey) with T2 weighting

Additional Monitoring

MRI

Structures to monitor: mastoid bone, what is left of the middle ear space, surrounding tissue of the temporal bone

• Postoperative tissue may look similar to a cholesteatoma

MRI (T2) After Mastoidectomy

THANKS

citation

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Heilbrun, M. E., Salzman, K. L., Glastonbury, C. M., Harnsberger, H. R., Kennedy, R. J., & Shelton, C. (2003). External Auditory Canal Cholesteatoma: Clinical and Imaging Spectrum. AJNR: American Journal of Neuroradiology, 24(4), 751–756. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148678/ Henninger, B., & Kremser, C. (2017). Diffusion weighted imaging for the detection and evaluation of cholesteatoma. World Journal of Radiology, 9(5), 217. https://doi.org/10.4329/wjr.v9.i5.217 Kennedy KL, Singh AK. Middle Ear Cholesteatoma. [Updated 2023 Jul 4]. In:StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448108/Pachpande, T. G., & Singh, C. V. (2022). Diagnosis and Treatment Modalities of Cholesteatomas: A Review. Cureus, 14(11), e31153. https://doi.org/10.7759/cureus.31153

Citation