cholesteatoma.pptx.middle ear disease wax

It looks like you’re asking about cholesteatoma (sometimes misspelled as cholestetoma). Here’s a clear overview for you:


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Cholesteatoma

Definition:
A cholesteatoma is an abnormal, noncancerous growth of keratinizing squamous epithelium in the middle ear and/or mastoid that can progressively enlarge and destroy nearby bone and structures.



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Types

1. Congenital cholesteatoma

Arises from embryonic epithelial cell rests, usually behind an intact tympanic membrane.

Typically presents in children with conductive hearing loss, no history of ear discharge.



2. Acquired cholesteatoma

More common.

Usually occurs after chronic middle ear infection, eustachian tube dysfunction, or tympanic membrane retraction.





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Pathogenesis

Chronic negative middle ear pressure → retraction pocket in pars flaccida or tensa.

Keratin accumulates in the pocket.

Progressive erosion of ossicles, mastoid bone, and even adjacent structures (facial nerve, labyrinth, dura).



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Clinical Features

Ear discharge: Persistent, foul-smelling, scanty, and non-resolving otorrhea.

Hearing loss: Mostly conductive type.

Complications (if untreated):

Ossicular destruction → severe hearing loss

Facial nerve palsy

Labyrinthine fistula (vertigo)

Intracranial complications: meningitis, brain abscess, lateral sinus thrombosis




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Diagnosis

Otoscopy: Retraction pocket, granulation tissue, pearly white debris behind tympanic membrane.

Pure tone audiometry: Conductive hearing loss.

HRCT temporal bone: To assess extent, ossicular erosion, mastoid involvement, complications.



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Treatment

Surgical (definitive):

Canal wall down mastoidectomy (modified radical mastoidectomy) – eradicates disease, creates a safe ear.

Canal wall up procedures – preserve anatomy but require close follow-up.


Medical: Antibiotics, aural toilet, ear drops (temporary; not curative).



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✅ Key Point:
Cholesteatoma is not a tumor but a destructive lesion. Untreated, it can cause life-threatening complications, so surgery is the treatment of choice.


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Do you want me to make a short exam-style answer (like a 5-mark/10-mark format) or a detailed notes version for study?
I think you mean Cholesteatoma 🙂
Here’s a compact explanation:


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Cholesteatoma

🔹 Definition:
An abnormal, non-cancerous collection of keratinizing squamous epithelium in the middle ear or mastoid, which gradually enlarges and destroys surrounding bone.


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Types

1. Congenital – arises from embryonic epithelial rests, usually behind an intact tympanic membrane.


2. Acquired – due to eustachian tube dysfunction, chronic otitis media, or tympanic membrane retraction.




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Clinical Features

Persistent, foul-smelling ear discharge (otorrhea)

Conductive hearing loss

Retraction pocket or pearly white mass seen on otoscopy

Possible complications:

Ossicular erosion → severe hearing loss

Facial nerve palsy

Labyrinthine fistula → vertigo

Intracranial complications (meningitis, brain absces

1. CHOLESTEATOMA

2. CHOLESTEATOMA Normally, middle ear cleft is lined by different types of epithelium in different regions: -ciliated columnar in the anterior and inferior part, cuboidal in the middle part and pavement-like in the attic. The middle ear is nowhere lined by keratinizing squamous epithelium. CHOLESTEATOMA-It is the presence of keratinizing squamous type of epithelium in the middle ear or mastoid .In other words, cholesteatoma is a "skin in the wrong place

3. cholesteatoma consists of two parts: ( i ) the matrix, which is made up of keratinizing squamous epithelium resting on a thin stroma of fibrous tissues and (ii) a central white mass, consisting of keratin debris produced by the matrix . For this reason, it has also been named epidermosis or keratoma

4. Origin of Cholesteatoma THEORIES :1. Presence of congenital cell rests. 2. Wittmaack's theory- Invagination of tympanic membrane from the attic or posterosuperior part of pars tensa in the form of retraction pockets . The outer surface of tympanic membrane is lined by stratified squamous epithelium which after invagination forms the matrix of cholesteatoma and lays down keratin in the pocket .3. Basal cell hyperplasia ( Ruedi's theory). The basal cells of germinal layer of skin proliferate under the influence of infection and lay down keratinizing squamous epithelium. 4. Epithelial invasion ( Habermann's theory). The epithelium from the meatus or outer drum surface grows into the middle ear through a pre-existing perforation. 5. Metaplasia (Sade's theory). Middle ear mucosa, like respiratory mucosa elsewhere, undergoes metaplasia due to repeated infections and transforms into squamous epithelium.

5. Classification of cholesteatoma The cholesteatoma is classified into :1. Congenital 2. Acquired, primary 3. Acquired, secondary 1). Congenital cholesteatoma . It arises from the embryonic epidermal cell rests in the middle ear cleft or temporal bone. Congenital cholesteatoma occurs at three important sites: a)middle ear, b)petrous apex and c)the cerebellopontine angle,

6. Congenital cholesteatoma

7. Acquired cholesteatoma Primary acquired Secondary acquired

8. Symptoms 1) Ear Discharge- scanty , foul smelling due to bone distruction 2) Hearing loss 3) Bleeding- from granulation tissue or polyp 4) vertigo 5) Facial weakness

9. Signs Retraction pocket Perforation Cholesteatoma

10. Investigation 1 Examination under microscope . All patients of chronic middle early disease should he examined under microscope. It may reveal presence of cholesteatoma, 2 . Tuning fork tests and audiogram . They are essential for preoperative assessment and to confirm the degree and type of hearing loss. 3 . X-ray mastoids/CT scan temporal bone. They indicate extent of bone destruction and degree of mastoid pneumatization . They. Cholesteatoma causes destruction in the area of attic and antrum (key area), better 4 . Culture and sensitivity of ear discharge. It helps to select proper antibiotic for local or systemic use.

11. Treatment 1)Surgical . It is the mainstay of treatment Primary aim in surgical treatment is to remove the disease and make the ear disease, preserve or reconstruct hearing 2 types of surgical procedures 1) Canal wall up 2) Canal wall down

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