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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. Kaffenberger TM et al: Prognostic factors of pediatric revision ossicular chain reconstruction. Otol Neurotol. 39(6):724-31, 2018
                                    2. Muzaffar J et al: Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clin Otolaryngol. 42(3):536-43, 2017
                                    3. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                    4. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                    5. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                    6. 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
                                    7. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                    8. 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
                                    9. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                    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: 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
                                    13. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                    14. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                    15. 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
                                    16. 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. Kaffenberger TM et al: Prognostic factors of pediatric revision ossicular chain reconstruction. Otol Neurotol. 39(6):724-31, 2018
                                                                      2. Muzaffar J et al: Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clin Otolaryngol. 42(3):536-43, 2017
                                                                      3. Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
                                                                      4. Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
                                                                      5. Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
                                                                      6. 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
                                                                      7. Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
                                                                      8. 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
                                                                      9. Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
                                                                      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: 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
                                                                      13. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                                                      14. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                                                      15. 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
                                                                      16. Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984