CHOLESTEATOMA

Pars Tensa Pattern

© Bruce Black MD

Severe adhesive otitis. Marked posterior pars tensa collapse, partial necrosis of the incus long process. Very early keratin accumulation on the scutum may indicate

impending cholesteatoma formation. © Bruce Black MD

Advanced Rt. Adhesive otitis. Invagination behind the lower pars tensa and incus necrosis. Early keratin debris accumulation at 9 0’clock indicates a Grade III to IV

change. © Bruce Black MD

Extensive drum invagination with overt keratin accumulation on the posterior scutum. The collapse resembles a true

drum , but the pocket lining is shiny rather than glistening. © Bruce Black MD

Subtotal drum collapse and breakdown antero-inferiorly .Probable chain pathology. Keratin accumulation postero-

superiorly. ? Early cholesteatoma. © Bruce Black MD

Stage III adhesive otitis. The incus has necrosed, and the stapes is obscured by a spherical mass of keratin, either as

a result of local infection or deeper invagination. © Bruce Black MD

Severe drum collapse, serous effusion present. Keratin accumulation over the incus and stapes with possible attic

extension. © Bruce Black MD

Localised collapse of the postero-superior pars tensa. Whilst debris is evident on the rim of the pocket, the deep

pocket appears clear. Possible early cholesteatoma. © Bruce Black MD

Localised drum retraction and debris accumulation around the rim and also in the deep pocket. Progressive pars tensa

cholesteatoma formation. © Bruce Black MD

Similar case to the previous. Keratin accumulation around and in the pocket, plus necrosis of the long process of the

incus. Stapes visible within the pocket. © Bruce Black MD

Substantial posterior drum collapse. Loss of the incus long process and stapes head. Accumulation of dry keratin emanating form the pocket. Impending cholesteatoma. © Bruce Black MD

An unusual anterior pars tensa deep retraction pocket. Prior removal of a keratin plug. Cholesteatomatous degeneration

progressing. © Bruce Black MD

Gross drum collapse, chain intact. Granulations in the hypotympanum, keratin debris in the posterior

hypotympanum and EAC. Advancing cholesteatoma. © Bruce Black MD

Subtotal drum collapse, dry keratin plug overlying the site of the probably necrosed incus and stapes. Impending

infection and active cholesteatoma formation. © Bruce Black MD

Moderate poterior drum collapse. Recent infection and keratin visible under the scutum indicate a pars tensa

cholesteatoma penetrating the attic. © Bruce Black MD

Active pars tensa cholesteatoma. Classic posterosuperior drum collapse and silvery moist semisolid keratin mass

projecting down from the attic extension. © Bruce Black MD

A large pocket is present containing moist keratin debris. The chain details are obscured but the incus and stapes

appear enveloped with squamous epithelium. © Bruce Black MD

Pars tensa cholesteatoma. Typical retraction pocket filled with silvery keratin extending superiorly into the attic.

Severely tympanosclerotic remaining pars tensa. © Bruce Black MD

Pars tensa cholesteatoma with postero-superior scutum erosion. A granulation overlies the lenticular process and

stapes. © Bruce Black MD

Right pars tensa cholesteatoma. Keratin debris is evident in the postero-superior invagination. The lower drum has a

large perforation due to atrophy from chronic tubal failure. © Bruce Black MD

Advanced pars tensa cholesteatoma. Gross drum collapse and extensive attic invagination. Profuse keratin and

granulations are present, extruding from the attic. © Bruce Black MD

Advanced pars tensa cholesteatoma. A large infected perforation is present below the mass of silvery gold keratin

protruding from the attic. © Bruce Black MD