Clinical features

The hallmarks of a cholesteatoma are:

• smelly (faecal) discharge and chronic drainage
  • often presents as chronic otorrhea unresponsive to antibiotic therapy (1)
• hearing loss
  • in 90 percent of patients there is conductive hearing loss caused by ossicular erosion (2)

Other symptoms depend on the extent of local expansion. Possible associated clinical features include:

• vertigo
• headache
• facial nerve palsy - caused by pressure
• cerebral abscess formation
• cerebellopontine angle syndrome

Otoscopy commonly shows, either:

• pearly, white, glistening debris occupying a perforation in the tympanic membrane - usually the pars flaccida
• crusting in the uppermost part of the ear drum - the attic - beneath which lies a cholesteatoma

Tuning fork tests usually show a conductive hearing loss.

Reference:

• (1) Cholesteatomas: Virtual classroom of the american academy of paediatrics.
• (2) Jon E. Isaacson and Neil M. Vora.Differential diagnosis and treatment of hearing loss. Am Fam Physician 2003;68:1125-32