2. Definition:
• Chronic pyogenic infection of middle ear cleft lasting
for >3 months with cholesteatoma & granulation
tissue in attic or postero-superior quadrant of pars
tensa
• Unsafe/ Dangerous : Higher chances of complication
due to bone erosion
• Hallmark of Disease : Cholesteatoma/granulations
3. Cholesteatoma
• Johannes Müller ( 1858)
• Defined as a three dimensional sac lined by
matrix of keratinizing stratified squamous
epithelium that rests on a thin layer of fibrous
tissue and contains desquamated keratin debris
which grows at the expense of surrounding bone
• Not a tumor and has no cholesterol
• Better term : Epidermosis
7. Congenital Cholesteatoma
• Persistence of congenital cell rests in middle ear,
petrous apex, cerebello-pontine angle
• Diagnostic criteria
– Intact TM
– No previous H/O otitis media
– Origin from embryonal inclusion of squamous
epithelium
8.
9. Acquired Cholesteatoma
1. Invagination / Retraction pocket (Wittmack’s
theory)
–One of the primary mechanism of
cholesteatoma formation
–Develops in posterosuperior quadrant of Pars
tensa /Attic with adjacent canal wall erosion
15. 6. Tertiary / Post-traumatic cholesteatoma
Mechanisms:
1. Epithelial entrapment in fracture line
2. Ingrowth of epithelium through fracture line
3. Traumatic implantation of epithelium into middle
ear
4. Entrapment of epithelium medial to E.A.C. stenosis
33. Medical - Conservative
• Topical ear drops + frequent suction clearance
• Indications:
– Early disease with shallow retraction pocket
– Only hearing ear with cholesteatoma
– Elderly patients
– Pts who are not fit for surgery under G.A.
– Pts who can regularly come for follow up
Treatment Options