CHOLESTEATOMA A Brief Overview - queenslandotology.com€¦ · Acquired cholesteatoma is the end...
Transcript of CHOLESTEATOMA A Brief Overview - queenslandotology.com€¦ · Acquired cholesteatoma is the end...
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© Bruce Black MD
CHOLESTEATOMA A Brief Overview
© Bruce Black MD
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DEFINITION A Sac/Cyst of Skin in the Ear
Not a neoplasm Frequently silent onset Capable of major complications
© Bruce Black MD
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CHOLESTEATOMA Classification
Congenital Acquired
Attic Pars tensa Combined Attic-Pars tensa
© Bruce Black MD
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Acquired cholesteatoma is the end Stage IV of adhesive otitis, where the drum collapse has invaginated into the
middle ear cleft, accumulating keratin debris. © Bruce Black MD
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Right Congenital cholesteatoma. Classic spherical “pearl”: a cyst of skin identical to external canal skin.
© Bruce Black MD
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Attic cholesteatoma is an invagination of canal skin via the pars flaccida, forming a sac within the middle ear cleft.
© Bruce Black MD
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Pars tensa cholesteatoma. Typical retraction pocket filled with silvery keratin extending superiorly into the attic.
Severely tympanosclerotic remaining pars tensa. © Bruce Black MD
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Combined attic-drum collapse pattern cholesteatoma.
© Bruce Black MD
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When infected, cholesteatoma has a foul discharge , which may be blood-stained if accompanied by an aural polyp
formation. © Bruce Black MD
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A conductive deafness is usually present, in this case accompanied by Type B tympanograms indicative of
accompanying middle ear effusions. © Bruce Black MD
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Complications of medial spread of cholesteatoma. 1. Conductive loss. 2. Facial palsy. 3. Fistula and bacterial
labyrinthitis (SN deafness, tinnitus, vertigo). © Bruce Black MD
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Complications of posterior cholesteatoma extension. 1. Acute mastoiditis. 2. Lateral sinus thrombosis, disseminated
abscesses, otitic hydrocephalus. 3. cerebellar abscess.
© Bruce Black MD
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Complications of superior extension of cholesteatoma. 1. Extradural middle fossa abscess. 2. Meningitis. 3. Subdural
abscess. 4. Cerebritis. 5. Temporal lobe abscess. © Bruce Black MD
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Rt. Facial paresis secondary to cholesteatomatous otitis media.
© Bruce Black MD
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Acute mastoiditis in a child, secondary to active attic cholesteatoma. Typical fluctuant subperiosteal abscess
overlying the superficial air cells postero-superior to the ear. © Bruce Black MD
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Otitic hydrocephalus secondary to past cholesteatoma, retrograde sigmoid sinus thrombosis, meningitis and
profound sensorineural deafness. © Bruce Black MD
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Axial CT scan showing marked cerebritis and cerebral abscess formation subsequent to chronic
cholesteatomatous otitis media. © Bruce Black MD
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Because of the risk of complications, microsurgery is mandatory in many cases.
© Bruce Black MD
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A major problem with surgery is a tendency for disease to persist as minute rests of residual cholesteatoma, or to
reform sacs. © Bruce Black MD
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Reforming drum collapse after cholesteatoma surgery. Precise repairs are essential to prevent this complication.
© Bruce Black MD
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To prevent recurrent sac formation the drum and canal wall are repaired with cartilage composite grafts.
© Bruce Black MD
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SUMMARY
A commonly covert disease Beware bloodstained or foul
otorrhoea Beware granulations or polyps in
the EAC Refer for specialist care if
suspected © Bruce Black MD