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cholesteoma
Infiltrate of keratinizing squamous epithelium & cholesterol in the middle ear.
Etiology:
1) generally results from chronic otitis media
2) congenital in rare cases
Pathology:
1) chronic eustachian tube dysfunction can result in recurrent otitis media [5]
- if persistent, can result in tympanostomy tube placement &/or chronic otitis media with tympanic membrane retraction & cholesteoma [5]
2) cholesteoma is a collection of keratinized epithelial debris in retraction pockets of the tympanic membrane
3) may impede tympanic membrane's ability to vibrate
4) squamous metaplasia or squamous epithelium-lined cyst formation may extend into the mastoid & erode surrounding bone
5) cyst may become secondarily infected & erode adjacent bone
6) disruption of ossicles
7) perforated tympanic membrane at the edge or margin can cause loss of the protective barrier of the annulus fibrosis
Clinical manifestations:
1) fullness in ear
2) earache
3) headache
4) conductive hearing loss
5) otoscopy
- keratinized debris above or at the superior aspect of the tympanic membrane
- chronic suppurative discharge from the middle ear through a perforated tympanic membrane (frequently at the margin)
- pearly white to gray mass behind the tympanic membrane visible with otoscope
- tympanic membrane appears retracted & concave, with a prominent lateral process of the malleus
- tympanic membrane may be immobile on pneumatic otoscopy
Radiology:
1) erosion of bone (ear ossicles)
2) enlargement of middle ear
3) opacification of mastoid air cells
Complications:
- superinfection (chronic suppurative otitis media)
- erosion of the ear ossicles
Management:
- consult ENT [4]
General
abnormal morphologic structure (malformation)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 41
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 874
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- NEJM Knowledge+ Otolaryngology