CHOLESTEATOMA

Dr Mahmoud diab
Assisstant lectuere
Dept of ENT & Head
Neck surgery
Zagazig
university
 Introduction
cholesteatoma is “ s k i n in th e w r o n g place

Sk in cells and c omponents found ins ide

middle ear cav ity that means metaplas tic
c hanges
 Classification of
COM
:Based on the disease pathogenesis
appears early during childhood : 1.Congenital
Acquired: on top of chronic ME illness.2
 Congenital cholesteatoma
Approximately 2% of the entire
. cholesteatoma cases

Mean age of presentation is

4.5 yrs

Derlacki and Levenson’s critria

 Theories of
Congenital
Cholesteatoma
:Epidermal rest theory ■
This theory is based on a finding of cell rests of non- ■
keratinizing squamous epithelial cells, localized in the lateral
.wall of the Eustachian tube, close to the tympanic ring

:Inclusion Theory ■
Other authors favor even a way of migration from cells ■
coming initially from the external ear through non evident
injuries of the tympanic membrane
 Acquired cholesteatoma

Most common type of

. cholesteatoma

– Divided into
.Primary acquired .1

Secondary .2
acquired
Primary
acquired

pars flaccida.1 .
, pocket
pars tensa 2
,pocket
combined .3
forms
Secondary
cholesteatoma
Secondary to infection, ■
trauma or perforation
Histopathology of cholesteatoma
Clinical presentation

Foul smelling discharge

Hearing loss
Persistent otitis externa
Vertigo, tinnitus
Balance disorder
.Facial paralysis
Mastoid abscess
Headache, otalgia, vomiting, seizure
Diagnosis

:Otoscopic examination ■
Audiometric evaluation

Pure tone audiometry- CHL ■

with good word recognition
.score
A conductive deficit more than ((
40 dB indicates ossicular
)).discontinuity
CT Scan

Not to diagnose
.To learn disease extent
We can evaluate the ossicles “ice cream
cone appearance “ for planning for surgery
? and so we decide what will we do
Non-depedant opacity “which means non
dependant to gravity “ on coronal cuts
indicates mostly cholestatoma sac in middle
ear cavity until prove otherwise
intraopertively
.MRI value in D.D
Treatmen
t
surgical Treatment is essentialy
-Choice of surgery will depend upon
Extent of disease
Available facilities
Surgeon’s expertise
Objective of
surgery
Total eradication of cholesteatoma to .1
.obtain a safe and dry ear
Maintain the best condition for a .2
successful wound healing process in the
.ear
Restore or maintain the best functional .3
.status of hearing
 Surgical
Procedures
A CWD mastoidectomy )1
CWU mastoidectomy )2
:Other procedures )3
..Reconstruction of the ear canal defect
Atticoantral mastoid obliteration can be done •
.after CWU or CWD
.Ossicular reconstruction must be decided
Complication of cholesteatoma

:Otogenic intracranial complication

,meningitis
Otitic hydrocephalus,
lateral sinus thrombosis,
.cavernous sinus thrombosis

intracranial sepsis-extradural, epidural,

subdural, peri-sigmoid sinus and
.cerebral abscess formation
Thank
you