Cholesteatoma

Posted by e-Medical PPT
16 year old female with left-sided otorrhea for two months
  • Otorrhea is yellow and foul-smelling
  • Otorrhea has not resolved with otic drops
  • Occasional dizziness
  • No fever
  • Otalgia has subsided
  • Intermittent unilateral tinnitus
  • Hearing loss
Physical Exam
Weber localizes to left
Rinne
AC > BC AD
BC > AC AS
Facial nerve intact
No nystagmus
Otherwise - within normal limits

Differential Diagnosis
  • Jugular bulb anomalies (high riding bulb, dehiscent jugular bulb, and jugular bulb diverticulum), aberrant internal carotid artery (ICA), hemangioma, persistent stapedial artery
  • Otitis Media, otitis externa, malignant otitis externa, tuberculous otitis
  • Tympanosclerosis
  • Granulomatous Diseases (a.k.a., Wegener’s granulomatosis)s
  • Osteoradionecrosis
  • Retained PE tube, Foreign Body
  • Cholesteatoma, paraganglioma / glomus tympanicum tumor, schwannoma, adenoma, endolymphatic sac tumor, cholesterol granuloma, polyps, adenocarcinoma, squamous cell carcinoma, adenoid cystic carcinoma
  • Cholesteatoma, encephalocele
Congenital or Acquired Cholesteatoma?
Congenital Cholesteatoma _Criteria
White mass medial to normal tympanic membrane
Normal pars flaccida and pars tensa
No prior history of otorrhea or perforations
No prior otologic procedures


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