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
Kaffenberger TM et al: Prognostic factors of pediatric revision ossicular chain reconstruction. Otol Neurotol. 39(6):724-31, 2018
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
Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
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
Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
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
Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
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
Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
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
Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
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
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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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
Kaffenberger TM et al: Prognostic factors of pediatric revision ossicular chain reconstruction. Otol Neurotol. 39(6):724-31, 2018
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
Chawla A et al: Computed tomography features of external auditory canal cholesteatoma: a pictorial review. Curr Probl Diagn Radiol. 44(6):511-6, 2015
Manasawala M et al: Imaging findings in auto-atticotomy. AJNR Am J Neuroradiol. 35(1):182-5, 2014
Dornhoffer JL et al: Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 21(5):440-5, 2013
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
Koitschev A et al: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma? Acta Otolaryngol. 133(5):443-8, 2013
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
Wilson KF et al: Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes. Laryngoscope. 123(12):3168-71, 2013
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
Mazita A et al: Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review. J Laryngol Otol. 125(11):1116-20, 2011
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
Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
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
Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984
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