Cholesteatoma

Case history #1

A 37-year-old man presents with hearing loss and a painful intermittent purulent discharge from his right ear. He also reports intermittent dizziness, and tinnitus in the right ear. On otoscopy, he has an attic crust on his right tympanic membrane. Examination with an otomicroscope and micro-suctioning reveals keratin in an attic retraction pocket. An audiogram demonstrates a conductive hearing loss on the right side.

Case history #2

A 12-year-old girl presents with a history of a recurrently discharging left ear for several months. She complains of an offensive discharge and hearing loss. She reports a previous history of grommet insertion. Otoscopy reveals a posterosuperior perforation of the tympanic membrane with a white keratin-like discharge. She has a conductive hearing loss on audiometry.

Other presentations

Congenital cholesteatoma is often an incidental finding. The patient may have hearing loss, and is found to have a white mass behind the tympanic membrane, with a normal pars tensa and pars flaccida of the tympanic membrane, and no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear.

Patients (more commonly adults) may also present with complications of a cholesteatoma, such as meningitis, facial palsy, sensorineural hearing loss, or vertigo, due to destruction of the cochlea or vestibular anatomy.