Ear, nose and throat (ENT)
Janesh K Gupta in Core Clinical Cases in Surgery and Surgical Specialties, 2014
The external ear canal and drum should be inspected. Start with the better ear and then proceed to the diseased side. Note whether there is any wax or debris in the external canal. This requires removal because the eardrum must be inspected fully. Do not syringe a discharging ear as this may transmit infection medially. The history in this case suggests chronic middle-ear disease with cholesteatoma. Cholesteatoma is the presence of squamous epithelium in the middle ear. This is thought to arise as a repercussion of ear infections. It can erode into middle-ear structures (ossicles, labyrinth, facial nerve) and may give rise to intracranial complications; this is why it is important to diagnose the condition. Brown/white smelly discharge is seen in the attic and also sometimes in the posterior part of the eardrum.
Data and Picture Interpretation Stations: Cases 1–45
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar in ENT OSCEs, 2023
Cholesteatoma is a disease of the middle ear in which a sac of keratinising squamous epithelium grows expansively and destructively. There is a strong association with eustachian tube dysfunction although cases can also be congenital or related to chronic tympanic membrane perforation. The diagnosis is made on clinical examination (looking with magnification is important) combined with audiometry which will usually demonstrate varying degrees of conductive hearing loss depending on how much of the middle ear has been eroded. Cases can still demonstrate normal hearing though, and if the inner ear is eroded in advanced disease then a sensorineural loss can result. A CT scan is standard to provide a surgical roadmap and information around hazards and complications. The treatment is tympanomastoid surgery which may be conducted in a number of different ways (canal wall up or down, with or without obliteration, with or without ossiculoplasty) based on surgeon preference and disease extent. The risks of surgery and complications of leaving disease untreated are both related to the surrounding anatomy, so an understanding of this will help answer such questions.
The Child with a Syndrome
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Otological aspects of the disease include the following: persistent otitis media with effusion – hearing aids should normally be offered to children with Down syndrome who have hearing loss due to OME5narrow and waxy ear canals – ventilator tube otorrhoea and early extrusion can be more commonconductive hearing loss secondary to ossicular anomaliessensorineural hearing loss with increased labyrinthine dysplasia – inner ear dysplasia is common in children with Down syndromeincreased incidence of cholesteatomaanatomical abnormalities of the facial nerve – tympanomastoid surgery can be especially challenging. Hearing screening with behavioural testing throughout early childhood should be carried out to establish near-normal hearing with the use of amplification or ventilation tube insertion. Cholesteatoma should be suspected in continuously discharging ears.
Analysis of Inflammatory and Homeostatic Roles of Tissue-resident Macrophages in the Progression of Cholesteatoma by RNA-Seq
Published in Immunological Investigations, 2021
Lian Fang, Lin Chen, Bi Lin, Liang Han, Kaiquan Zhu, Qifa Song
Cholesteatoma is a benign, sac-like skin growth behind the eardrum in the middle ear. This gradual growth often causes erosion of surrounding bones, leading to various complications such as subsequent hearing loss, vestibular dysfunction, and intracranial complications (Migirov et al. 2009; Olszewska et al. 2004). Cholesteatoma is usually initiated by the chronic infection that invokes inflammatory response to attract immune cells, such as Langerhans’ cells, T-cells, and macrophages, to the site of cholesteatoma (Kim and Tinling et al. 2002). When the eardrum (tympanic membrane) doesn’t work well, negative air pressure can build up and pull part of the eardrum inward (Nagai et al. 2006). This causes the loss of its self-cleaning ability and makes a sac filling with old skin cells and other waste materials (Olszewska et al. 2004). However, the explanation for the transition from a retraction sac of skin to cholesteatoma still lacks and has been a subject of debate for decades (Louise 2010).
Expression of PTHrP and RANKL in acquired middle ear cholesteatoma epithelium
Published in Acta Oto-Laryngologica, 2020
Shumin Xie, Zhen Pan, Tuanfang Yin, Jihao Ren, Wei Liu
Characterized by destructive squamous epithelial cell hyper-proliferation, middle ear cholesteatoma is a chronic disease usually accompanied with otitis media, which gradually expands and leads to serious complications by destruction of nearby bony structures. Erosion caused by bone resorption of the neighboring bony structures may result in hearing loss, vestibular dysfunction, facial paralysis, labyrinthine fistulae and intracranial complications. Although Four mainstream theories underlying the etiopathogenesis of acquired cholesteatoma including retraction pocket theory, immigration theory, squamous metaplasia theory and basal cell hyperplasia theory have been put forward for decades [1], no single theory has been able to explain the clinical characteristics of all cholesteatoma types. Our previous study demonstrated that epithelial hyper-proliferation played an essential role in the etiopathogenesis of acquired middle ear cholesteatoma [2]. Despite a wide spectrum of opinions on etiopathogenesis, the progressive bone resorption has been regarded as the most important and destructitve characteristic of acquired middle ear cholesteatoma [3]. Nowadays, more and more researchers have devoted themselves to exploring the etiopathogenesis of bone resorption in cholesteatoma, however, the exact mechanism still remains unclear. Consequently, a comprehensive understanding on etiopathogenesis of bone resorption could aid in decreasing the risk of hearing loss as well as intracranial and extracranial complications.
Cholesteatoma in chronic otitis media secondary to pars tensa perforation
Published in Acta Oto-Laryngologica, 2023
Caili Ji, Xiaowen Zhang, Xudong Yan, Songli Cao, Tao Fu
We designed this study to explore factors related to the formation of cholesteatoma secondary to pars tensa perforation. We retrospectively recruited subjects with acquired cholesteatoma with pars tensa perforation in different sites. Patients should satisfy following conditions: 1) chronic otitis media with pars tensa perforation with or without adhesion in the perforation edge; 2) patients with ear discharge and earache as first symptoms other than hearing loss to identify from congenital cholesteatoma; 3) to distinguish from pocket retraction cholesteatoma, patients with retraction pockets in either pars flaccid or pars tensa, or with history of otitis media effusion were excluded from the study; 4) patients with history of middle ear surgery, nasopharyngeal tumor, and cleft palate were also excluded.
Related Knowledge Centers
- Balance Disorder
- Epithelium
- Facial Nerve
- Ossicles
- Otitis Externa
- Tinnitus
- Headache
- Mastoid Part of The Temporal Bone
- Base of Skull
- Ear Pain