Materiały źródłowe

• #1 Middle Ear Cholesteatoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448108/

  Cholesteatomas are benign but expansive aggregations of keratinized squamous debris within the middle ear, which can damage surrounding structures. […] The diagnosis is clinical and supported by history, physical examination, audiometry, and imaging. […] This activity enhances the diagnosis, treatment, and management of middle ear cholesteatoma, ultimately improving patient care and quality of life. […] Common signs include progressive hearing loss and persistent foul-smelling otorrhea that is resistant to medical therapy. […] Cholesteatoma is primarily diagnosed through clinical evaluation, including history, physical examination, audiometry, and imaging. […] A thorough risk assessment is essential for every patient to evaluate the likelihood of further hearing loss, facial nerve paralysis, and vestibular or intracranial complications.

• #1 Diagnosis and Treatment Modalities of Cholesteatomas: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9731553/

  A cholesteatoma is diagnosed through otoscopic examination, CT, MRI, and tympanometric and audiometric tests. […] The following tests are carried out to check for hearing loss: An audiogram is carried out to assess the eardrum, middle ear, and hearing. CT scan of the ear helps to see if there is damage to the ear bones. MRI is done if there is a concern that the cholesteatoma is spreading through the skull base. […] Otoscopy, which includes video-otoscopy, otomicroscopy, and video-telescopy, is the most direct and effective technique for inspecting the eardrum. […] The main imaging technique used in this field to assess the severity of the condition and aid in the development of a surgical strategy is CT. […] MRI: Due to the various pulse sequences used in MRI, complementing information is provided, improving tissue distinction. […] Tympanometric and audiometric tests are ancillary diagnostic methods that can be used to assess cholesteatomas.

• #1 Diagnosis and Treatment of Cholesteatoma – Clinical Advisor

  https://www.clinicaladvisor.com/features/diagnosis-treatment-cholesteatoma/

  Patients with recurrent ear infections should be evaluated for cholesteatoma. […] Cholesteatoma detection should begin at the primary care level by recognizing untreatable or repeated ear infections. […] Cholesteatoma should be among several differential diagnoses when a patient presents with ongoing ear pain. […] Early recognition and thorough history and physical are imperative to make a timely referral to an otologist. […] Computed tomography (CT) and magnetic resonance imaging (MRI) are the gold standards for preoperative assessment of extension of bone erosion with cholesteatoma. […] The gold standard for treatment is the surgical removal of the mass to prevent further spread and decrease infection. […] The long-term prognosis for cholesteatoma is good with early diagnosis, surgical removal, and close follow-up. […] Cholesteatoma detection should begin at the primary care level by recognizing untreatable or repeated ear infections.

• #1 Cholesteatoma: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/cholesteatoma

  How is a cholesteatoma diagnosed? To determine whether you have a cholesteatoma, your doctor will examine the inside of your ear using an otoscope. This medical device allows your doctor to see if there are signs of a growing cyst. Specifically, they will look for a visible deposit of skin cells or a large mass of blood vessels in the ear. […] Your doctor may need to order a CT scan if there are no obvious signs of a cholesteatoma. A CT scan might also be ordered if you’re showing certain symptoms, such as dizziness and facial muscle weakness. A CT scan is a painless imaging test that captures images from a cross section of your body. The scan allows your doctor to see inside your ear and skull. This can help them better visualize the cyst or rule out other possible causes of your symptoms.

• #1 Cholesteatoma – Symptoms, Diagnosis, TreatmentGroup 9Group 49Group 9Group 49

  https://www.barrowneuro.org/condition/cholesteatoma/

  Cholesteatoma Diagnosis […] Fortunately, diagnosing a cholesteatoma is relatively uncomplicated. If you’re experiencing any of the symptoms outlined above, your healthcare provider will refer you to an ear, nose, and throat (ENT) specialist, where one or more of these exams and imaging tests will be used: […] Physical exam: First, your ENT specialist will thoroughly examine your ears using an otoscope, an instrument with a light and magnifying lens. They’ll look for signs of cholesteatoma, like an abnormal growth or a perforated eardrum. In some cases, the specialist may use a small, flexible camera called an endoscope to examine the ear more closely and assess the extent of your cholesteatoma. […] Hearing tests: To assess the range of hearing loss, your specialist will order an audiogram, as well as any other accessory hearing tests, to determine if the cholesteatoma affects your hearing. […] Computed tomography (CT) scan: A CT scan of the temporal bone surrounding the ear will provide detailed images of your ear structure using multiple X-rays from different angles combined into one image. This, in turn, determines the size and extent of the cholesteatoma and whether it has damaged the surrounding structures, like the inner ear. […] Magnetic resonance imaging (MRI): In some cases, an MRI may provide more detailed imaging of soft tissues to help differentiate cholesteatoma from other types of masses or lesions. […] Balance tests: If you have symptoms of vertigo or balance issues, balance testing can determine if the cholesteatoma affects the inner ear structures responsible for equilibrium. […] Used as needed, these diagnostic tests will help your healthcare team create the right cholesteatoma treatment plan for you.

• #1 Cholesteatoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1033

  Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. […] Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent. […] Key diagnostic factors include presence of risk factors, hearing loss, ear discharge resistant to antibiotic therapy, attic crust in retraction pocket, and white mass behind intact tympanic membrane. […] 1st investigations to order include pure tone audiogram and CT scan of the petrous temporal bones. […] Investigations to consider include fistula test, MRI scan of the head and petrous temporal bones, and bacterial culture.

• #1 Cholesteatoma Workup: Approach Considerations, Audiometry, Computed Tomography

  https://emedicine.medscape.com/article/860080-workup

  No laboratory tests or biopsies are generally necessary for the diagnosis of cholesteatoma, as the diagnosis relies heavily on clinical history, physical examination, and radiographic findings. […] CT scanning is the diagnostic imaging modality of choice for these lesions, as it can detect subtle bony defects in the setting of a middle ear and/or mastoid lesion. […] CT scanning is the imaging modality of choice in the diagnosis of cholesteatoma, as it can detect subtle bony defects in the temporal bone. […] In a study of 64 patients with middle ear cholesteatomas, Gaurano and Joharjy found that the diagnosis of cholesteatoma was suggested by specific characteristics found on CT scans. […] Some surgeons believe that any patient with a cholesteatoma who is scheduled for surgical intervention should have a preoperative CT scan; it provides useful information in every circumstance, and, consequently, the expense of the scan and the radiation exposure involved are typically justified.

• #1 Cholesteatoma: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/860080-overview

  No laboratory tests or biopsies are generally necessary for the diagnosis of cholesteatoma, as the diagnosis relies heavily on clinical history, physical examination, and radiographic findings. […] Computed tomography (CT) scanning is the diagnostic imaging modality of choice for these lesions, as it can detect subtle bony defects. Imaging findings may include the following: Nondependent soft tissue density, typically with involvement of the epitympanum and Prussak space; Scutum blunting; Ossicular erosion (malleus and incus); Mastoid aditus widening; Bony ear canal erosion (external auditory canal [EAC] cholesteatoma). […] Cholesteatoma can also erode into the facial canal, tegmen tympani, lateral semicircular canal, sigmoid plate, and posterosuperior EAC; this can also be detected on CT imaging.

• #1 Cholesteatoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cholesteatoma?lang=us

  Cholesteatomas are histologically equivalent to an epidermoid cyst and are composed of desquamated keratinizing stratified squamous epithelium forming a mass. […] A CT scan is an important component of assessing patients with possible cholesteatoma. It is not as specific as MRI but is able to obtain excellent bony details required for preoperative planning (reconstruction of ossicles if needed) and to exclude perforation of the bony tegmen. […] Conventional non-contrast MR imaging with diffusion-weighted imaging is recommended in all patients with suspected cholesteatoma. An MRI should be performed especially in patients with previous surgery for cholesteatoma since recurrence or residual tumor can be detected with great accuracy, whereas appearances on CT can be non-specific. […] With these findings, recurrent cholesteatomas as small as a few millimeters can be detected with near 100% specificity.

• #1 Acquired cholesteatoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acquired-cholesteatoma?lang=us

  Although MRI is unable to adequately delineate bony anatomy, it can potentially distinguish non-specific opacification from cholesteatomas. […] Surgical excision is curative. However, recurrence is not uncommon because the lesion is often difficult to remove completely. […] Cholesteatoma is difficult to differentiate on CT from other middle ear masses without bony erosion with MRI helpful in differentiating cholesteatoma from other entities.

• #1 Cholesteatoma: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/860080-overview

  Magnetic resonance imaging (MRI) is used when the following anomalies are suspected: Dural involvement or invasion; Subdural or epidural abscess; Brain herniation into mastoid cavity; Inflammation of membranous labyrinth or facial nerve; Sigmoid sinus thrombosis; Meningitis. […] Audiometry should be performed prior to surgery whenever possible. Air and bone conduction, speech reception threshold, and speech discrimination tests should all be conducted before the proposed operative procedure, to establish a hearing baseline. […] Histologically, surgically removed cholesteatoma specimens demonstrate typical squamous epithelium. The histology is indistinguishable from that of sebaceous cysts or keratomas removed from any other part of the body.

• #1 Cholesteatoma Workup: Approach Considerations, Audiometry, Computed Tomography

  https://emedicine.medscape.com/article/860080-workup

  A study by Baba et al indicated that temporal subtraction CT (TSCT) scanning in combination with conventional CT imaging is superior to conventional CT scanning alone in diagnosing recurrent/residual cholesteatoma following primary cholesteatoma surgery. […] If ossicular involvement is apparent on preoperative CT scanning, patients should be counseled that ossicular removal may be necessary and that significant postoperative conductive hearing loss should be expected. […] MRI reveals cholesteatoma as isointense on T1 sequences without enhancement from contrast and hyperintense on T2 sequences. […] A number of articles suggest that diffusion-weighted MRI may be able to distinguish between recurrent or persistent middle ear cholesteatoma, scar tissue, and granulation tissue. […] A study by Lips et al compared the diagnostic performance of 1.5 T to that of 3 T non-EPI DWI, as employed to detect residual and/or recurrent cholesteatoma.

• #1 Neuroradiology of Cholesteatomas | American Journal of Neuroradiology

  http://www.ajnr.org/content/32/2/221

  HRCT is the imaging technique of choice in case of a clinically suspected cholesteatoma. HRCT, due to its excellent spatial resolution, has a high sensitivity with a high NPV when it shows a free middle ear or mastoid. However, specificity is low in the case of a mass lesion because it may correspond to granulation tissue, secretion, cholesterol granuloma, or neoplasm. […] MR imaging provides complementary information due to the different pulse sequences, leading to a better tissue differentiation. […] In the past 7 years, several reports have shown that diffusion-weighted single-shot spin-echo echo-planar sequences can be useful in the diagnosis of cholesteatomas. […] The most recent method for the diagnosis of recurrent cholesteatoma is the multishot fast spin-echo DWI-PROPELLER technique. […] In summary, HRCT and MR imaging with DWI remain complementary examinations, which are both necessary in the accurate diagnosis of a recurrent/residual cholesteatoma to avoid unnecessary second-look operations.

• #1

  https://link.springer.com/article/10.1007/s00330-024-11021-x

  MRI technique: non-echoplanar imaging (EPI) (or multi-shot EPI) DWI sequences should be preferentially acquired over single-shot EPI DWI sequences, and they are the optimal imaging technique for cholesteatoma detection (moderate evidence). […] Residual disease: non-EPI (or multi-shot EPI) DWI with supplementary anatomical sequences plays a key role in imaging surveillance of postoperative cholesteatoma and this should be continued for at least 5 years (moderate evidence). […] Imaging plays a significant role in the appropriate management of patients with middle ear cholesteatomas. […] MRI is invaluable. Protocols that include non-EPI DWI can accurately detect residual cholesteatoma (unless very small 23mm). […] As a result, MRI surveillance represents an alternative to routine second-look surgery in patients who have undergone CWUM or obliterative or reconstructive techniques that would limit clinical detection of residual disease.

• #1 Cholesteatoma Workup: Approach Considerations, Audiometry, Computed Tomography

  https://emedicine.medscape.com/article/860080-workup

  A study by Yamashita et al indicated that fusing images from high-resolution three-dimensional diffusion-weighted MRI and multi-detector row CT scanning is useful in operative planning for cholesteatoma surgery. […] A study by Locketz et al indicated that combining temporal bone CT scanning with PROPELLER diffusion-weighted MRI is superior to PROPELLER diffusion-weighted MRI alone for the preoperative identification and localization of cholesteatomas.

• #1 Middle Ear Cholesteatoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448108/

  Imaging can provide valuable guidance in the evaluation and management of cholesteatoma. […] Despite thorough clinical assessment and radiological findings, an otolaryngologist must be prepared for unexpected intraoperative findings. […] Audiometry should be conducted both before and after surgery, including the following assessments: Air and bone conduction, Speech reception thresholds, Speech discrimination, Tympanometry, Acoustic reflexes, Auditory brain response for select patients. […] Some studies suggest combining temporal bone CT and diffusion-weighted MRI to enhance diagnostic sensitivity and specificity. […] The treatment of cholesteatoma is primarily surgical unless contraindicated by secondary medical conditions. […] The preferred surgical approach is tympanoplasty to repair the tympanic membrane and mastoidectomy to remove the disease from the mastoid bone. […] Most patients recover well after surgery and have a favorable prognosis. […] Long-term follow-up should involve otomicroscopy and audiological assessments.

• #1 Cholesteatoma | Symptoms, Diagnosis & Therapy | hear.com Malaysia

  https://www.hear.com/my/cholesteatoma/

  The diagnosis is usually confirmed using three different methods: 1. Ear microscopy. Typical findings here are an eardrum defect, white epithelial scales and possibly bone erosion (progressive destruction) of the wall of the ear canal near the eardrum. […] 2. CT examination (computed tomography). Here the exact extent of the bone destruction can usually be determined very well. 3. Hearing test (tone audiogram). Usually one finds conductive hearing loss in cholesteatoma patients, i.e. a hearing disorder that only affects the outer/inner ear. However, if the cholesteatoma is so advanced that the inner ear is already affected, a so-called sensorineural disorder is present.

• #1

  https://www.aurorahealthcare.org/services/otolaryngology/cholesteatoma-symptoms-treatment

  Cholesteatoma diagnosis involves an exam and discussion of symptoms with your doctor. They will look inside your ear with an otoscope to check for abnormalities in the eardrum. […] They may order tests such as an audiogram, CT scan or MRI. Also, an electronystagmography can be used to study eye movements and see how well nerves in the brain are working.

• #1 Pathology Outlines – Cholesteatoma

  https://www.pathologyoutlines.com/topic/earcholesteatoma.html

  Cholesteatoma is a benign, nonneoplastic destructive lesion in the middle ear or mastoid, most commonly unilateral. […] Accumulation of keratinizing stratified squamous epithelium and keratinous debris, with stromal fibrosis and associated inflammatory reaction, leads to destruction of adjacent structures (e.g., bone) including components of ossicular chain, eventually producing clinical symptoms. […] Treatment is surgical but may recur locally. […] Untreated cholesteatoma progresses, can become infected and can lead to conductive hearing loss and serious intracranial complications. […] Diagnosis rests on the presence of 3 key components: keratinous material (anucleate keratin squamous), keratinizing stratified squamous epithelium, and inflamed fibrous connective tissue stroma. […] Clinical symptoms (see Clinical features).

• #1 Middle ear-acquired cholesteatoma diagnosis based on CT scan image mining using supervised machine learning models | Beni-Suef University Journal of Basic and Applied Sciences | Full Text

  https://bjbas.springeropen.com/articles/10.1186/s43088-024-00534-5

  Distinguishing between middle ear cholesteatoma and chronic suppurative otitis media (CSOM) is an ongoing challenge. […] While temporal bone computed tomography (CT) scan is highly accurate for diagnosing middle ear conditions, its specificity in discerning between cholesteatoma and CSOM is only moderate. […] To address this issue, we utilized trained machine learning models to enhance the specificity of temporal bone CT scan in diagnosing middle ear cholesteatoma. […] Relying solely on clinical ear examination may not consistently provide the precision required to differentiate between cholesteatoma and other categories of chronic otitis media. […] Therefore, clinicians frequently request imaging techniques to enhance preoperative assessment. […] Ayache et al. recommend the use of a high-resolution preoperative computed tomography scan (HRCT) not only for its unequivocal utility in assessing disease extension and anatomical variations but also as an effective diagnostic modality.

• #1

  https://link.springer.com/article/10.1007/s00330-024-11021-x

  Although non-malignant, middle ear cholesteatoma can result in significant complications due to local bone erosion and infection. […] Imaging plays a pivotal role in the management of patients with middle ear cholesteatoma aiding clinical diagnosis, identifying complications, planning surgery, and detecting residual disease at follow-up. […] The ability of magnetic resonance imaging with non-echoplanar diffusion-weighted sequences to accurately detect residual disease has led to a shift in the diagnostic paradigm for post-surgical follow-up of cholesteatoma, such that routine second-look surgery is no longer required. […] Diagnosis and preoperative planning: high-resolution CT can be used to clarify clinical diagnosis, detect complications, and delineate surgical anatomy; MRI is only indicated in very specific situations (low evidence).

• #1 Middle Ear Cholesteatoma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25128

  Cholesteatoma can be either an epidermoid cyst arising from aberrant embryonic nests in the congenital form or a benign, expanding tumor of keratinizing squamous epithelium that may cause locoregional inflammation, infection, and destruction. […] Both types of acquired cholesteatomas present significant challenges in diagnosis, treatment, and management due to their insufficient blood supply. […] Common signs include progressive hearing loss and persistent foul-smelling otorrhea that is resistant to medical therapy. […] Acquired cholesteatomas can damage the hearing mechanism, specifically the tympanic membrane and ossicles, disrupt eustachian tube function, erode the tegmen mastoideum, cause dehiscence of the facial nerve, alter vestibular function, and, in rare cases, lead to central nervous system (CNS) complications.

• #1 Cholesteatoma Diagnosis & Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/ear-institute/conditions/cholesteatoma

  Cholesteatoma is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid (arrow). Cholesteatoma grows aggressively. Because it retains bacteria, it is a commonly becomes infected. This infection may not go away until the cholesteatoma is removed. Cholesteatoma has the capacity to eat away bone. Bone erosion can lead to hearing loss by destroying the small hearing bones (malleus, incus, stapes) that carry sound in the middle ear. […] While these complications are rare, they are very serious and can be prevented by removing the cholesteatoma as soon as possible. […] Although surgery is rarely urgent, once a cholesteatoma is found, surgical treatment is the only choice. Surgery usually involves a mastoidectomy to remove the disease from the bone, and tympanoplasty to repair the eardrum. The exact type of operation is determined by the stage of the disease at the time of surgery.

• #1 Middle Ear Cholesteatoma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25128

  Cholesteatoma is primarily diagnosed through clinical evaluation, including history, physical examination, audiometry, and imaging. […] A thorough risk assessment is essential for every patient to evaluate the likelihood of further hearing loss, facial nerve paralysis, and vestibular or intracranial complications. […] While cholesteatoma typically requires surgical intervention, in some cases, watchful waiting and close follow-up may be preferred. […] Imaging can provide valuable guidance in the evaluation and management of cholesteatoma. […] Despite thorough clinical assessment and radiological findings, an otolaryngologist must be prepared for unexpected intraoperative findings, such as a larger cholesteatoma mass with more extensive destruction. […] The treatment of cholesteatoma is primarily surgical unless contraindicated by secondary medical conditions (eg, cardiac or pulmonary disease) that pose too high a risk for anesthesia.

• #2 Cholesteatoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1033

  Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. […] Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent. […] Key diagnostic factors include presence of risk factors, hearing loss, ear discharge resistant to antibiotic therapy, attic crust in retraction pocket, and white mass behind intact tympanic membrane. […] 1st investigations to order include pure tone audiogram and CT scan of the petrous temporal bones. […] Investigations to consider include fistula test, MRI scan of the head and petrous temporal bones, and bacterial culture.

• #2 Middle Ear Cholesteatoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448108/

  Cholesteatomas are benign but expansive aggregations of keratinized squamous debris within the middle ear, which can damage surrounding structures. […] The diagnosis is clinical and supported by history, physical examination, audiometry, and imaging. […] This activity enhances the diagnosis, treatment, and management of middle ear cholesteatoma, ultimately improving patient care and quality of life. […] Common signs include progressive hearing loss and persistent foul-smelling otorrhea that is resistant to medical therapy. […] Cholesteatoma is primarily diagnosed through clinical evaluation, including history, physical examination, audiometry, and imaging. […] A thorough risk assessment is essential for every patient to evaluate the likelihood of further hearing loss, facial nerve paralysis, and vestibular or intracranial complications.

• #2 Middle Ear Cholesteatoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448108/

  Imaging can provide valuable guidance in the evaluation and management of cholesteatoma. […] Despite thorough clinical assessment and radiological findings, an otolaryngologist must be prepared for unexpected intraoperative findings. […] Audiometry should be conducted both before and after surgery, including the following assessments: Air and bone conduction, Speech reception thresholds, Speech discrimination, Tympanometry, Acoustic reflexes, Auditory brain response for select patients. […] Some studies suggest combining temporal bone CT and diffusion-weighted MRI to enhance diagnostic sensitivity and specificity. […] The treatment of cholesteatoma is primarily surgical unless contraindicated by secondary medical conditions. […] The preferred surgical approach is tympanoplasty to repair the tympanic membrane and mastoidectomy to remove the disease from the mastoid bone. […] Most patients recover well after surgery and have a favorable prognosis. […] Long-term follow-up should involve otomicroscopy and audiological assessments.

• #2 Cholesteatoma – Wikipedia

  https://en.wikipedia.org/wiki/Cholesteatoma

  Cholesteatoma is diagnosed by a medical doctor by physical examination of the ear. A CT scan may help to rule out other, often more serious causes for the patient’s clinical presentation. Non-ionizing radiation imaging techniques (MRI) may be suitable to replace a CT scan, if determined necessary by a physician. […] Doctors’ initial inspections may only reveal an ear canal full of discharge. Until the doctor has cleaned the ear and inspected the entire tympanic membrane, cholesteatoma cannot be diagnosed.

• #2 Cholesteatoma Treatment – Common ENT Problems Treated at NCEENT

  https://www.nceent.com/otolaryngology/cholesteatoma

  MRI (Magnetic Resonance Imaging): An MRI can be useful for diagnosing complex or recurrent cholesteatoma cases, particularly for distinguishing cholesteatoma from other masses or post-surgical changes. […] Endoscopic Examination: […] Endoscopy of the Ear Canal: Sometimes, an endoscope is used to get a closer view of the ear structures, particularly if the cholesteatoma is located in areas that are hard to visualize with an otoscope. […] Clinical History and Symptoms: Collecting a detailed history of symptoms such as recurrent ear infections, drainage, hearing loss, tinnitus, dizziness, or facial nerve symptoms can help guide the diagnosis, as these are common symptoms associated with cholesteatoma. […] Diffusion-Weighted MRI (DWI-MRI): In some cases, especially with recurrent cholesteatoma, a DWI-MRI is used because it can specifically highlight the presence of keratin debris characteristic of cholesteatoma, offering a clearer diagnosis in follow-up cases or cases where CT findings are inconclusive. […] These diagnostic methods help ENT specialists determine the presence, size, and impact of cholesteatoma on surrounding structures, enabling them to plan effective treatment.

• #2 Cholesteatoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1033

  Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. […] Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent. […] Key diagnostic factors include hearing loss, ear discharge resistant to antibiotic therapy, attic crust in retraction pocket, and white mass behind intact tympanic membrane. […] 1st tests to order include pure tone audiogram and CT scan of the petrous temporal bones. […] Tests to consider include fistula test, MRI scan of the head and petrous temporal bones, and bacterial culture.

• #2 Cholesteatoma Workup: Approach Considerations, Audiometry, Computed Tomography

  https://emedicine.medscape.com/article/860080-workup

  No laboratory tests or biopsies are generally necessary for the diagnosis of cholesteatoma, as the diagnosis relies heavily on clinical history, physical examination, and radiographic findings. […] CT scanning is the diagnostic imaging modality of choice for these lesions, as it can detect subtle bony defects in the setting of a middle ear and/or mastoid lesion. […] CT scanning is the imaging modality of choice in the diagnosis of cholesteatoma, as it can detect subtle bony defects in the temporal bone. […] In a study of 64 patients with middle ear cholesteatomas, Gaurano and Joharjy found that the diagnosis of cholesteatoma was suggested by specific characteristics found on CT scans. […] Some surgeons believe that any patient with a cholesteatoma who is scheduled for surgical intervention should have a preoperative CT scan; it provides useful information in every circumstance, and, consequently, the expense of the scan and the radiation exposure involved are typically justified.

• #2 Neuroradiology of Cholesteatomas | American Journal of Neuroradiology

  http://www.ajnr.org/content/32/2/221

  SUMMARY: The relevant aspects of cholesteatomas are reviewed with the emphasis on their diagnosis by using cross-sectional imaging. The indications and limitations of CT and MR imaging and the use of novel MR imaging techniques in the diagnosis of cholesteatomas are described. […] HRCT provides information about bony changes and intracranial complications; however, it is inaccurate for characterizing the soft-tissue mass in the temporal bone. In the past 7 years, improvements in MR imaging techniques have enhanced the sensitivity and specificity of radiologic diagnosis, which may lead to future avoidance of second-look surgeries in cases of residual/recurrent cholesteatomas. […] The purpose of this review article is to summarize all aspects of cholesteatomas, including their definition, history, etymology, epidemiology, classification, histology, pathophysiology, clinical signs, and neuroradiologic diagnosis. We review the latest studies on the application of new MR imaging techniques for the accurate diagnosis of cholesteatomas.

• #2 Neuroradiology of Cholesteatomas | American Journal of Neuroradiology

  http://www.ajnr.org/content/32/2/221

  HRCT is the imaging technique of choice in case of a clinically suspected cholesteatoma. HRCT, due to its excellent spatial resolution, has a high sensitivity with a high NPV when it shows a free middle ear or mastoid. However, specificity is low in the case of a mass lesion because it may correspond to granulation tissue, secretion, cholesterol granuloma, or neoplasm. […] MR imaging provides complementary information due to the different pulse sequences, leading to a better tissue differentiation. […] In the past 7 years, several reports have shown that diffusion-weighted single-shot spin-echo echo-planar sequences can be useful in the diagnosis of cholesteatomas. […] The most recent method for the diagnosis of recurrent cholesteatoma is the multishot fast spin-echo DWI-PROPELLER technique. […] In summary, HRCT and MR imaging with DWI remain complementary examinations, which are both necessary in the accurate diagnosis of a recurrent/residual cholesteatoma to avoid unnecessary second-look operations.

• #2 Acquired cholesteatoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acquired-cholesteatoma?lang=us

  Cholesteatomas occur far more commonly in the middle ear than in the external auditory canal. This article relates to middle ear acquired cholesteatomas. […] Acquired cholesteatomas make up 98% of all middle ear cholesteatomas. […] The vast majority of acquired cholesteatomas develop due to chronic otitis media and are usually associated with perforation of the tympanic membrane. Clinical presentation usually consists of conductive hearing loss, often with purulent discharge from the ear. […] CT is the modality of choice for diagnostic assessment of cholesteatomas, due to its ability to demonstrate the bony anatomy of the temporal bone in exquisite detail. Cholesteatomas appear as regions of soft tissue density, exerting mass effect and resulting in bony erosion, with the latter the hallmark of cholesteatoma.

• #2 Comprehensive Management of Cholesteatoma in Otitis Media: Diagnostic Challenges, Imaging Advances, and Surgical Outcome

  https://www.mdpi.com/2077-0383/13/22/6791

  In addition to conventional radiography, computed tomography (CT) has become a key imaging tool for evaluating cholesteatomas. CT scans provide high-resolution images that allow for the detailed visualization of bone erosion, including the involvement of the ossicular chain, mastoid cells, and other surrounding structures. This imaging modality is particularly useful for preoperative planning, as it helps delineate the extent of the cholesteatoma and guides surgical intervention. […] Magnetic resonance imaging (MRI) can also play a role in the evaluation of cholesteatomas, particularly in differentiating between residual or recurrent disease and postoperative changes. Diffusion-weighted (DWI) MRI is highly sensitive to the presence of keratinous debris, which is characteristic of cholesteatomas. DWI can detect small cholesteatomas and is especially useful for postoperative follow-up to identify residual or recurrent lesions that may not be visible on CT scans. […] The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients.

• #2 Cholesteatoma: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/860080-overview

  Magnetic resonance imaging (MRI) is used when the following anomalies are suspected: Dural involvement or invasion; Subdural or epidural abscess; Brain herniation into mastoid cavity; Inflammation of membranous labyrinth or facial nerve; Sigmoid sinus thrombosis; Meningitis. […] Audiometry should be performed prior to surgery whenever possible. Air and bone conduction, speech reception threshold, and speech discrimination tests should all be conducted before the proposed operative procedure, to establish a hearing baseline. […] Histologically, surgically removed cholesteatoma specimens demonstrate typical squamous epithelium. The histology is indistinguishable from that of sebaceous cysts or keratomas removed from any other part of the body.

• #2

  https://link.springer.com/article/10.1007/s00330-024-11021-x

  MRI technique: non-echoplanar imaging (EPI) (or multi-shot EPI) DWI sequences should be preferentially acquired over single-shot EPI DWI sequences, and they are the optimal imaging technique for cholesteatoma detection (moderate evidence). […] Residual disease: non-EPI (or multi-shot EPI) DWI with supplementary anatomical sequences plays a key role in imaging surveillance of postoperative cholesteatoma and this should be continued for at least 5 years (moderate evidence). […] Imaging plays a significant role in the appropriate management of patients with middle ear cholesteatomas. […] MRI is invaluable. Protocols that include non-EPI DWI can accurately detect residual cholesteatoma (unless very small 23mm). […] As a result, MRI surveillance represents an alternative to routine second-look surgery in patients who have undergone CWUM or obliterative or reconstructive techniques that would limit clinical detection of residual disease.

• #2 Pathology Outlines – Cholesteatoma

  https://www.pathologyoutlines.com/topic/earcholesteatoma.html

  Detailed otoscopic examination findings: most commonly pearly white masses (intact) or white-yellow debris in the middle ear. […] Imaging measures, such as high resolution computed tomography (HRCT) and in some cases, non echo planar diffusion weighted magnetic resonance imaging (MRI). […] Histopathology additionally supports the diagnosis.

• #2 Middle ear-acquired cholesteatoma diagnosis based on CT scan image mining using supervised machine learning models | Beni-Suef University Journal of Basic and Applied Sciences | Full Text

  https://bjbas.springeropen.com/articles/10.1186/s43088-024-00534-5

  Indeed, temporal bone computed tomography (CT) scans with 1-mm slices provide high spatial resolution for evaluating ear anatomy, making them a valuable preoperative tool. […] Nevertheless, their sensitivity for diagnosing cholesteatoma fluctuates from 72.73% to 88%, while specificity is only moderate, ranging from 66 to 77.22%. […] Our study suggests an alternative approach for the automated diagnosis of CSOM versus cholesteatoma based on trained machine learning models using HRCT scan native images. […] To enhance the specificity of temporal bone HRCT scans for the diagnosis of middle ear cholesteatoma versus CSOM, we trained several machine learning models on a dataset of native HRCT scans of both conditions. […] The prediction step of the trained machine learning classifiers was performed on a different dataset.

• #2 Cholesteatoma – ENT Health

  https://www.enthealth.org/conditions/cholesteatoma/

  Cholesteatoma can be managed in a variety of ways, but definitive removal of the skin or cyst typically requires surgical intervention. […] The specific type of surgery depends on what part of the ear is involved with the cholesteatoma. […] Other times imaging, often a CT scan, helps to define where the cholesteatoma is located. […] A hearing test, or audiogram, should be obtained. […] The primary goal of cholesteatoma surgery is to remove the skin, clear the infection, and create a dry, safe ear. […] In some cases, a second surgery may be required to make sure all the cholesteatoma has been removed before the hearing bones can be rebuilt. […] After surgery, follow-up office visits will be needed to clean your ear, recheck your hearing, and evaluate the results. Cholesteatoma requires long-term surveillance to check for recurrence.

• #2 Cholesteatoma Diagnosis & Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/ear-institute/conditions/cholesteatoma

  Cholesteatoma is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid (arrow). Cholesteatoma grows aggressively. Because it retains bacteria, it is a commonly becomes infected. This infection may not go away until the cholesteatoma is removed. Cholesteatoma has the capacity to eat away bone. Bone erosion can lead to hearing loss by destroying the small hearing bones (malleus, incus, stapes) that carry sound in the middle ear. […] While these complications are rare, they are very serious and can be prevented by removing the cholesteatoma as soon as possible. […] Although surgery is rarely urgent, once a cholesteatoma is found, surgical treatment is the only choice. Surgery usually involves a mastoidectomy to remove the disease from the bone, and tympanoplasty to repair the eardrum. The exact type of operation is determined by the stage of the disease at the time of surgery.

• #2 Cholesteatoma Diagnosis & Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/ear-institute/conditions/cholesteatoma

  Cholesteatoma surgery, which is delicate surgery performed under a microscope, usually takes 2 to 3 hours, and patients may go home the same day. It is very important to remove the disease completely, or it may grow back. The rate of re-growth is higher in children than adults. Because of the aggressive nature of cholesteatoma, we ask patients come in regularly for careful follow-up. Sometimes a second operation will be necessary. […] Patients with cholesteatoma usually have hearing loss prior to surgery. We try to reconstruct the hearing whenever possible. This usually results in hearing improvement, but not always. Inflammation and scar tissue can sometimes prevent a good hearing result. A second-stage operation can be attempted in the future when the ear is stable and there is no more disease.

• #2 Cholesteatoma | Bay Audiology

  https://www.bayaudiology.co.nz/diseases-and-symptoms/cholesteatoma

  Cholesteatoma diagnosis requires a multi-pronged approach, including visual examinations, hearing tests and computer imaging, such as CT scans. […] Your doctor will start with an otoscopy a visual inspection of the eardrum as the first step in diagnosing cholesteatoma. […] Your doctor or healthcare professional may also conduct an in-depth hearing test to assess the extent of hearing loss caused by the growth’s impact on the middle ear and may refer you to an ear, nose and throat specialist for a CT scan and to discuss treatment. […] Imaging techniques like CT scans provide more detailed visuals of the ear’s internal structures, which helps in accurate diagnosis. […] Early detection plays a major role in preventing complications, including hearing loss, damage to important ear structures and potential spread of infections, and also ensures the right treatment can be administered promptly so if youre experiencing any of the above cholesteatoma symptoms, book in to see your GP today.

• #3 Cholesteatoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1033

  Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. […] Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent. […] Key diagnostic factors include hearing loss, ear discharge resistant to antibiotic therapy, attic crust in retraction pocket, and white mass behind intact tympanic membrane. […] 1st tests to order include pure tone audiogram and CT scan of the petrous temporal bones. […] Tests to consider include fistula test, MRI scan of the head and petrous temporal bones, and bacterial culture.

• #3 Pathology Outlines – Cholesteatoma

  https://www.pathologyoutlines.com/topic/earcholesteatoma.html

  Detailed otoscopic examination findings: most commonly pearly white masses (intact) or white-yellow debris in the middle ear. […] Imaging measures, such as high resolution computed tomography (HRCT) and in some cases, non echo planar diffusion weighted magnetic resonance imaging (MRI). […] Histopathology additionally supports the diagnosis.

• #3

  https://link.springer.com/article/10.1007/s00330-024-11021-x

  Although non-malignant, middle ear cholesteatoma can result in significant complications due to local bone erosion and infection. […] Imaging plays a pivotal role in the management of patients with middle ear cholesteatoma aiding clinical diagnosis, identifying complications, planning surgery, and detecting residual disease at follow-up. […] The ability of magnetic resonance imaging with non-echoplanar diffusion-weighted sequences to accurately detect residual disease has led to a shift in the diagnostic paradigm for post-surgical follow-up of cholesteatoma, such that routine second-look surgery is no longer required. […] Diagnosis and preoperative planning: high-resolution CT can be used to clarify clinical diagnosis, detect complications, and delineate surgical anatomy; MRI is only indicated in very specific situations (low evidence).

• #3

  https://link.springer.com/article/10.1007/s00330-024-11021-x

  MRI technique: non-echoplanar imaging (EPI) (or multi-shot EPI) DWI sequences should be preferentially acquired over single-shot EPI DWI sequences, and they are the optimal imaging technique for cholesteatoma detection (moderate evidence). […] Residual disease: non-EPI (or multi-shot EPI) DWI with supplementary anatomical sequences plays a key role in imaging surveillance of postoperative cholesteatoma and this should be continued for at least 5 years (moderate evidence). […] Imaging plays a significant role in the appropriate management of patients with middle ear cholesteatomas. […] MRI is invaluable. Protocols that include non-EPI DWI can accurately detect residual cholesteatoma (unless very small 23mm). […] As a result, MRI surveillance represents an alternative to routine second-look surgery in patients who have undergone CWUM or obliterative or reconstructive techniques that would limit clinical detection of residual disease.

• #3 Chronic Otitis Media, Cholesteatoma and Mastoiditis – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-otitis-media-cholesteatoma-and-mastoiditis-a-to-z

  Chronic otitis media with cholesteatoma A persistent hole in the eardrum sometimes can lead to a cholesteatoma, a growth (tumor) in the middle ear made of skin cells and debris. A cholesteatoma also can form when there is no hole, such as when the eustachian tube is blocked. Cholesteatomas can cause hearing loss and are prone to get infected, which can cause ear drainage. Cholesteatomas can grow large enough to erode the middle ear structures and the mastoid bone behind the middle ear. […] To confirm the diagnosis, he or she will look inside the ear with a special light called an otoscope and may take a sample of drainage fluid to be examined in a laboratory. […] If the otolaryngologist suspects mastoiditis or a cholesteatoma, additional tests may be needed. These could include x-rays, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan. […] A cholesteatoma can cause repeated infections and often must be removed with surgery. […] Surgery is not required in most cases, but may be necessary to correct a persistent eardrum perforation or to remove a cholesteatoma.

• #3 Middle Ear Cholesteatoma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25128

  The preferred surgical approach is tympanoplasty to repair the tympanic membrane and mastoidectomy to remove the disease from the mastoid bone, collectively known as tympanomastoidectomy. […] Most patients recover well after surgery and have a favorable prognosis. […] Long-term follow-up should involve otomicroscopy and audiological assessments.

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