Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
⚠️ Cholesteatoma = a keratinising squamous epithelium cyst in the middle ear that expands and destroys local structures and bone. It is not a true tumour, but behaves in an aggressive, locally destructive way. Untreated → serious intracranial complications.
📖 About
- Enlarging collection of squamous epithelium + keratin debris within the middle ear and mastoid.
- Most often arises with chronic otitis media or eustachian tube dysfunction.
- Causes gradual erosion of ossicles, mastoid, and occasionally cochlea or facial nerve canal.
- Can be congenital (remnants from embryonic epithelium) or acquired (post-inflammatory).
🩺 Clinical Features
- Persistent, foul-smelling otorrhoea resistant to standard therapy.
- Conductive hearing loss due to ossicular damage or obstruction.
- Pearly white mass seen behind tympanic membrane on otoscopy.
- Advanced disease: vertigo, tinnitus, headache.
- Facial nerve palsy (VII) = red flag complication.
- Secondary infection may worsen discharge and pain.
🔎 Investigations
- Audiometry: Quantifies conductive ± mixed hearing loss.
- CT temporal bone: Defines bony erosion, mastoid involvement.
- MRI: Better for soft tissue & differentiating from granulation/inflammatory tissue.
- Microbiology: If superimposed infection suspected.
⚠️ Complications
- Destruction of ossicles → permanent hearing loss.
- Bony erosion into surrounding structures (mastoid, labyrinth, facial canal).
- Intracranial spread: meningitis, brain abscess, venous sinus thrombosis.
- VII nerve palsy: facial weakness/paralysis.
- Inner ear spread → labyrinthitis with vertigo + sensorineural loss.
💊 Management
- Urgent ENT referral for all suspected cases.
- Surgery = mainstay: excision + mastoidectomy ± tympanoplasty to remove disease and reconstruct hearing.
- Tympanoplasty if tympanic membrane perforated.
- Regular follow-up essential due to high recurrence risk (repeat otoscopy ± imaging).
- Adjunct: topical/ systemic antibiotics only if active infection present (not definitive).
📌 Exam Pearls
- Key clue: foul-smelling discharge + hearing loss + pearly mass behind TM.
- Always mention risk of intracranial complications → urgency of ENT referral.
- Chronic otitis media with cholesteatoma = destructive, unlike chronic otitis media without cholesteatoma.
