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Pars Flaccida Cholesteatoma
Nicholas A. Koontz, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Pars flaccida cholesteatoma (PFC)
            • Synonyms

              • Attic or Prussak space cholesteatoma
              • Primary acquired cholesteatoma
            • Definitions

              • Nonneoplastic mass-like accumulation of exfoliated keratin within stratified squamous epithelium, Prussak space origin

            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

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Gulotta G et al: Facial nerve dehiscence and cholesteatoma: a comparison between decades. J Int Adv Otol. 16(3):367-72, 2020
                                          2. Norris CD et al: Diffusion MR imaging in the head and neck: principles and applications. Neuroimaging Clin N Am. 30(3):261-82, 2020
                                          3. Komori M et al: Practical analysis of pars flaccida cholesteatoma with classification and staging system proposed by Japan Otological Society: a comparative study. Acta Otolaryngol. 138(11):977-80, 2018
                                          4. Matsuda K et al: Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: a multicenter study of 446 surgical cases in Japan. Auris Nasus Larynx. 45(1):45-50, 2018
                                          5. Rosito LS et al: Classification of cholesteatoma according to growth patterns. JAMA Otolaryngol Head Neck Surg. 142(2):168-72, 2016
                                          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, 2016
                                          7. Dündar Y et al: Does diffusion-weighted MR imaging change the follow-up strategy in cases with residual cholesteatoma? J Int Adv Otol. 11(1):58-62, 2015
                                          8. Garrido L et al: Diagnostic capacity of non-echo planar diffusion-weighted MRI in the detection of primary and recurrent cholesteatoma. Acta Otorrinolaringol Esp. 66(4):199-204, 2015
                                          9. Jackler RK et al: A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope. 125 Suppl 4:S1-14, 2015
                                          10. Karandikar A et al: Evaluation of cholesteatoma: our experience with DW propeller imaging. Acta Radiol. 56(9):1108-12, 2015
                                          11. Lincot J et al: Middle ear cholesteatoma: compared diagnostic performances of two incremental MRI protocols including non-echo planar diffusion-weighted imaging acquired on 3T and 1.5T scanners. J Neuroradiol. 42(4):193-201, 2015
                                          12. Songu M et al: Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma. Acta Otolaryngol. 135(8):776-80, 2015
                                          13. Yiğiter AC et al: Value of echo-planar diffusion-weighted magnetic resonance imaging for detecting tympanomastoid cholesteatoma. J Int Adv Otol. 11(1):53-7, 2015
                                          14. Akiyama N et al: Influence of continuous negative pressure in the rat middle ear. Laryngoscope. 124(10):2404-10, 2014
                                          15. Alvo A et al: Use of non-echo-planar diffusion-weighted MR imaging for the detection of cholesteatomas in high-risk tympanic retraction pockets. AJNR Am J Neuroradiol. 35(9):1820-4, 2014
                                          16. Li PM et al: Evaluating the utility of non-echo-planar diffusion-weighted imaging in the preoperative evaluation of cholesteatoma: a meta-analysis. Laryngoscope. 123(5):1247-50, 2013
                                          17. Karmody CS et al: The pathogenesis of acquired cholesteatoma of the human middle ear: support for the migration hypothesis. Otol Neurotol. 33(1):42-7, 2012
                                          18. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                          19. Jeunen G et al: The value of magnetic resonance imaging in the diagnosis of residual or recurrent acquired cholesteatoma after canal wall-up tympanoplasty. Otol Neurotol. 29(1):16-8, 2008
                                          20. De Foer B et al: The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma. Neuroradiology. 49(10):841-8, 2007
                                          21. Persaud R et al: Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol. 121(11):1013-9, 2007
                                          22. De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
                                          23. Vercruysse JP et al: The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur Radiol. 16(7):1461-7, 2006
                                          24. 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
                                          25. Iino Y et al: Risk factors for recurrent and residual cholesteatoma in children determined by second stage operation. Int J Pediatr Otorhinolaryngol. 46(1-2):57-65, 1998
                                          26. Robert Y et al: Petrous bone extension of middle-ear acquired cholesteatoma. Acta Radiol. 37(2):166-70, 1996
                                          27. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                          28. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                          29. Chole RA et al: Comparative histology of the tympanic membrane and its relationship to cholesteatoma. Ann Otol Rhinol Laryngol. 98(10):761-6, 1989
                                          30. Meyerhoff WL et al: Cholesteatoma staging. Laryngoscope. 96(9 Pt 1):935-9, 1986
                                          31. 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

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Pars flaccida cholesteatoma (PFC)
                                                    • Synonyms

                                                      • Attic or Prussak space cholesteatoma
                                                      • Primary acquired cholesteatoma
                                                    • Definitions

                                                      • Nonneoplastic mass-like accumulation of exfoliated keratin within stratified squamous epithelium, Prussak space origin

                                                    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

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Gulotta G et al: Facial nerve dehiscence and cholesteatoma: a comparison between decades. J Int Adv Otol. 16(3):367-72, 2020
                                                                                  2. Norris CD et al: Diffusion MR imaging in the head and neck: principles and applications. Neuroimaging Clin N Am. 30(3):261-82, 2020
                                                                                  3. Komori M et al: Practical analysis of pars flaccida cholesteatoma with classification and staging system proposed by Japan Otological Society: a comparative study. Acta Otolaryngol. 138(11):977-80, 2018
                                                                                  4. Matsuda K et al: Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: a multicenter study of 446 surgical cases in Japan. Auris Nasus Larynx. 45(1):45-50, 2018
                                                                                  5. Rosito LS et al: Classification of cholesteatoma according to growth patterns. JAMA Otolaryngol Head Neck Surg. 142(2):168-72, 2016
                                                                                  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, 2016
                                                                                  7. Dündar Y et al: Does diffusion-weighted MR imaging change the follow-up strategy in cases with residual cholesteatoma? J Int Adv Otol. 11(1):58-62, 2015
                                                                                  8. Garrido L et al: Diagnostic capacity of non-echo planar diffusion-weighted MRI in the detection of primary and recurrent cholesteatoma. Acta Otorrinolaringol Esp. 66(4):199-204, 2015
                                                                                  9. Jackler RK et al: A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope. 125 Suppl 4:S1-14, 2015
                                                                                  10. Karandikar A et al: Evaluation of cholesteatoma: our experience with DW propeller imaging. Acta Radiol. 56(9):1108-12, 2015
                                                                                  11. Lincot J et al: Middle ear cholesteatoma: compared diagnostic performances of two incremental MRI protocols including non-echo planar diffusion-weighted imaging acquired on 3T and 1.5T scanners. J Neuroradiol. 42(4):193-201, 2015
                                                                                  12. Songu M et al: Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma. Acta Otolaryngol. 135(8):776-80, 2015
                                                                                  13. Yiğiter AC et al: Value of echo-planar diffusion-weighted magnetic resonance imaging for detecting tympanomastoid cholesteatoma. J Int Adv Otol. 11(1):53-7, 2015
                                                                                  14. Akiyama N et al: Influence of continuous negative pressure in the rat middle ear. Laryngoscope. 124(10):2404-10, 2014
                                                                                  15. Alvo A et al: Use of non-echo-planar diffusion-weighted MR imaging for the detection of cholesteatomas in high-risk tympanic retraction pockets. AJNR Am J Neuroradiol. 35(9):1820-4, 2014
                                                                                  16. Li PM et al: Evaluating the utility of non-echo-planar diffusion-weighted imaging in the preoperative evaluation of cholesteatoma: a meta-analysis. Laryngoscope. 123(5):1247-50, 2013
                                                                                  17. Karmody CS et al: The pathogenesis of acquired cholesteatoma of the human middle ear: support for the migration hypothesis. Otol Neurotol. 33(1):42-7, 2012
                                                                                  18. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                                                                  19. Jeunen G et al: The value of magnetic resonance imaging in the diagnosis of residual or recurrent acquired cholesteatoma after canal wall-up tympanoplasty. Otol Neurotol. 29(1):16-8, 2008
                                                                                  20. De Foer B et al: The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma. Neuroradiology. 49(10):841-8, 2007
                                                                                  21. Persaud R et al: Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol. 121(11):1013-9, 2007
                                                                                  22. De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
                                                                                  23. Vercruysse JP et al: The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur Radiol. 16(7):1461-7, 2006
                                                                                  24. 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
                                                                                  25. Iino Y et al: Risk factors for recurrent and residual cholesteatoma in children determined by second stage operation. Int J Pediatr Otorhinolaryngol. 46(1-2):57-65, 1998
                                                                                  26. Robert Y et al: Petrous bone extension of middle-ear acquired cholesteatoma. Acta Radiol. 37(2):166-70, 1996
                                                                                  27. Mafee MF: MRI and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol. 22(4):239-48, 1993
                                                                                  28. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                                                                  29. Chole RA et al: Comparative histology of the tympanic membrane and its relationship to cholesteatoma. Ann Otol Rhinol Laryngol. 98(10):761-6, 1989
                                                                                  30. Meyerhoff WL et al: Cholesteatoma staging. Laryngoscope. 96(9 Pt 1):935-9, 1986
                                                                                  31. Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984