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Cholesteatoma (Diagnosis (History (POH
Bloods, scans, growth, gestation,
…
Cholesteatoma
Diagnosis
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Examination
ENT
Retracted tympanic membrane, yellow/brown crusty lesion upper part of membrane; if congenital, lesion will be pearly white
May have pus or perforated membrane
History
POH
Bloods, scans, growth, gestation,
delivery, weight, complications
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PC/HPC
Hearing loss, smelly discharge
Vertigo, headaches, ear pain, facial paralysis
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SH
Living arrangements, school/nursery,
parental smoking status
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Pathophysiology
Cause
Congenital
Squamous epithelium trapped in middle ear during embryogenesis and expands
Conductive hearing loss
Acquired
Chronic negative middle ear pressure causes
weakness in upper tympanic membrane and retraction
Drawn down and inwards forming a pouch, trapping epithelum
Pouch becomes filled with keratin, outer layer releases
enzymes causing local destruction
Mechanism
Benign collection of keratinising sqaumous epithelium
Can become infected or become locally destructive
Releases lytic enzymes, eroding tympanic membrane and bone
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Management
Conservative
Information, advice, support
Refer to ENT/paeds ASAP
Surgery
Myringoplasty/Mastoidectomy
Indication: all patients
MOA: repair of tympanic membrane,
removal of cholesteatoma
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