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Acquired Cholesteatoma
Bernadette L. Koch, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Secondary or acquired cholesteatoma (ACh): Stratified squamous epithelium-lined sac filled with exfoliated keratin debris in middle ear (ME)
              • Attic or Prussak space ACh = pars flaccida cholesteatoma (PFCh)
              • Pars tensa ACh (PTCh) lies in posterior mesotympanum, medial to ossicles
                • Sinus cholesteatoma = PTCh involving sinus tympani
            • Due to abnormal migration of ectoderm in external auditory canal (EAC) spontaneously or 2° to surgery/trauma

          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

                                    • Reporting Tips

                                      Selected References

                                      1. Fischer N et al: MRI of middle ear cholesteatoma: the importance of observer reliance from diffusion sequences. J Neuroimaging. ePub, 2021
                                      2. Gulotta G et al: Facial nerve dehiscence and cholesteatoma: pediatrics vs adults. Int J Pediatr Otorhinolaryngol. 138:110260, 2020
                                      3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                      4. Shekdar KV et al: Imaging of pediatric hearing loss. Neuroimaging Clin N Am. 29(1):103-15, 2019
                                      5. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                      6. 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
                                      7. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                      8. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                      9. 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
                                      10. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                      11. 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
                                      12. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                      13. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                      14. 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
                                      15. Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
                                      16. De Foer B et al: Diffusion-weighted magnetic resonance imaging of the temporal bone. Neuroradiology. 52(9):785-807, 2010
                                      17. 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
                                      18. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                      19. 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
                                      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

                                              • Definitions

                                                • Secondary or acquired cholesteatoma (ACh): Stratified squamous epithelium-lined sac filled with exfoliated keratin debris in middle ear (ME)
                                                  • Attic or Prussak space ACh = pars flaccida cholesteatoma (PFCh)
                                                  • Pars tensa ACh (PTCh) lies in posterior mesotympanum, medial to ossicles
                                                    • Sinus cholesteatoma = PTCh involving sinus tympani
                                                • Due to abnormal migration of ectoderm in external auditory canal (EAC) spontaneously or 2° to surgery/trauma

                                              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

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Fischer N et al: MRI of middle ear cholesteatoma: the importance of observer reliance from diffusion sequences. J Neuroimaging. ePub, 2021
                                                                          2. Gulotta G et al: Facial nerve dehiscence and cholesteatoma: pediatrics vs adults. Int J Pediatr Otorhinolaryngol. 138:110260, 2020
                                                                          3. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                                                          4. Shekdar KV et al: Imaging of pediatric hearing loss. Neuroimaging Clin N Am. 29(1):103-15, 2019
                                                                          5. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                                                          6. 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
                                                                          7. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                                                          8. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                                                          9. 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
                                                                          10. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                                                          11. 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
                                                                          12. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                                                          13. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                                                          14. 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
                                                                          15. Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
                                                                          16. De Foer B et al: Diffusion-weighted magnetic resonance imaging of the temporal bone. Neuroradiology. 52(9):785-807, 2010
                                                                          17. 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
                                                                          18. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                                                          19. 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