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Acquired Cholesteatoma
Bernadette L. Koch, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Secondary or acquired cholesteatoma (ACh)
          • Definitions

            • Stratified, squamous epithelium-lined sac filled with exfoliated keratin debris in middle ear (ME)
              • "Attic" or Prussak space ACh = pars flaccida cholesteatoma (PFC)
              • Pars tensa ACh (PTC) in posterior mesotympanum, medial to ossicles
                • Sinus cholesteatoma = PTC involving sinus tympani

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                    2. van Egmond SL et al: A systematic review of non-echo planar diffusion-weighted magnetic resonance imaging for detection of primary and postoperative cholesteatoma. Otolaryngol Head Neck Surg. 154(2):233-40, 2015
                                    3. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                    4. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                    5. Geoffray A et al: MRI for the diagnosis of recurrent middle ear cholesteatoma in children--can we optimize the technique? Preliminary study. Pediatr Radiol. 43(4):464-73, 2013
                                    6. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                    7. Lingam RK et al: Apparent diffusion coefficients for detection of postoperative middle ear cholesteatoma on non-echo-planar diffusion-weighted images. Radiology. 269(2):504-10, 2013
                                    8. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                    9. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                    10. De Foer B: Non echo planar, diffusion-weighted magnetic resonance imaging (periodically rotated overlapping parallel lines with enhanced reconstruction sequence) compared with echo planar imaging for the detection of middle-ear cholesteatoma. J Laryngol Otol. 125(8):877-8; author reply 878, 2011
                                    11. Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
                                    12. De Foer B et al: Diffusion-weighted magnetic resonance imaging of the temporal bone. Neuroradiology. 52(9):785-807, 2010
                                    13. De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
                                    14. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                    15. Watts S et al: A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma. J Laryngol Otol. 114(4):248-53, 2000
                                    16. Fageeh NA et al: Surgical treatment of cholesteatoma in children. J Otolaryngol. 28(6):309-12, 1999
                                    17. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                    18. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                    19. Mafee MF et al: Cholesteatoma of the middle ear and mastoid. A comparison of CT scan and operative findings. Otolaryngol Clin North Am. 21(2):265-93, 1988
                                    20. Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Secondary or acquired cholesteatoma (ACh)
                                            • Definitions

                                              • Stratified, squamous epithelium-lined sac filled with exfoliated keratin debris in middle ear (ME)
                                                • "Attic" or Prussak space ACh = pars flaccida cholesteatoma (PFC)
                                                • Pars tensa ACh (PTC) in posterior mesotympanum, medial to ossicles
                                                  • Sinus cholesteatoma = PTC involving sinus tympani

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                                                      2. van Egmond SL et al: A systematic review of non-echo planar diffusion-weighted magnetic resonance imaging for detection of primary and postoperative cholesteatoma. Otolaryngol Head Neck Surg. 154(2):233-40, 2015
                                                                      3. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                                                      4. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                                                      5. Geoffray A et al: MRI for the diagnosis of recurrent middle ear cholesteatoma in children--can we optimize the technique? Preliminary study. Pediatr Radiol. 43(4):464-73, 2013
                                                                      6. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                                                      7. Lingam RK et al: Apparent diffusion coefficients for detection of postoperative middle ear cholesteatoma on non-echo-planar diffusion-weighted images. Radiology. 269(2):504-10, 2013
                                                                      8. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                                                      9. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                                                      10. De Foer B: Non echo planar, diffusion-weighted magnetic resonance imaging (periodically rotated overlapping parallel lines with enhanced reconstruction sequence) compared with echo planar imaging for the detection of middle-ear cholesteatoma. J Laryngol Otol. 125(8):877-8; author reply 878, 2011
                                                                      11. Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
                                                                      12. De Foer B et al: Diffusion-weighted magnetic resonance imaging of the temporal bone. Neuroradiology. 52(9):785-807, 2010
                                                                      13. De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
                                                                      14. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                                                      15. Watts S et al: A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma. J Laryngol Otol. 114(4):248-53, 2000
                                                                      16. Fageeh NA et al: Surgical treatment of cholesteatoma in children. J Otolaryngol. 28(6):309-12, 1999
                                                                      17. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                                                      18. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                                                      19. Mafee MF et al: Cholesteatoma of the middle ear and mastoid. A comparison of CT scan and operative findings. Otolaryngol Clin North Am. 21(2):265-93, 1988
                                                                      20. Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984