Consultation with the Specialist: Cholesteatomas

OBJECTIVES

After completing this article, readers should be able to:

1. Describe the classic appearance and location of congenital cholesteatomas.

2. List the two broad categories of cholesteatomas.

3. Describe what response to multiple courses of antibiotics should raise the index of suspicion for cholesteatoma.

4. Describe the treatment that always is required for cholesteatoma.

5. Describe the common prognosis for cholesteatoma.

At the turn of the century, medical texts described cholesteatomas as destructive processes that were the primary cause of frequent and usually fatal intracranial complications of common ear disease. These lesions are far less deadly today, in large part due to better antibiotics, imaging techniques, and surgical management, but they remain common. Simply stated, a cholesteatoma is a benign skin tumor, usually occurring in the middle ear and mastoid spaces. Sometimes it can be difficult to diagnose early through the hand-held otoscope. The characteristic glistening white growths can appear as vague, irregular, unremarkable whitish structures that resemble tympanosclerosis, but they can be distinguished more easily under high-power microscopy.

Cholesteatomas were described initially late in the 19th century and misnamed because of their resemblance to cholesterol deposits in the large vessels. In reality, they contain no more cholesterol than the skin cells of which they are made.

Definition

A cholesteatoma is a hamartomatous-like, keratin-producing squamous epithelial lesion that is constructed very much like an onion, in layers. The bulk of these tumors consists of desquamated skin deposited into a core of shed dead cells called …