Recent advances in diagnosis and treatment of cholesteatoma

Cholesteatoma represents the presence of the stratified squamous epithelium within the middle ear space that clinically has two significant properties, namely secondary infection and bone erosion. Cholesteatoma may be either congenital or acquired. Unlike primary acquired cholesteatoma, congenital cholesteatoma typically does not present with a prior history of otorrhea, tympanic membrane perforation, or previous surgery. While there is hearing loss (usually conductive initially), the tympanic membrane is typically normal. With a close inspection, however, a pearly white mass medial to the ear drum is often noted. High resolution computed tomography (HRCT) is still widely considered to be the primary imaging tool for diagnosing and documenting the extent and potential complications of middle ear cholesteatoma. The additional value of MRI in cholesteatoma is due to its capacity to unequivocally confirm the diagnosis of cholesteatoma in cases of clinical doubt; in its capacity to distinguish cholesteatoma from other soft tissues, such as fibrosis, granulation tissue and cholesterol granuloma; and it’s potential to document invasion of the labyrinth and of the intracranial space. Cholesteatoma is still considered a surgical disease requiring either the complete removal of its squamous lined matrix or its exteriorization for continued aural toilet and ventilation. Management of cholesteatoma continues to pose a surgical challenge, and the choice of surgical technique depends on the extension of the disease, the surgeon’s own experience and skills.