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Pars Tensa Cholesteatoma
Nicholas A. Koontz, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Pars tensa cholesteatoma (PTC)
              • Middle ear (ME)
            • Synonyms

              • Sinus cholesteatoma, due to involvement of sinus tympani
              • Secondary acquired cholesteatoma
            • Definitions

              • Focal accumulation of exfoliated keratin within stratified squamous epithelium at site of perforation or retraction pocket at pars tensa portion of tympanic membrane (TM)
                • "Tense" lower 2/3 of TM

            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. 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
                                          2. Shinnabe A et al: Differences in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas. Eur Arch Otorhinolaryngol. 271(8):2171-5, 2014
                                          3. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                          4. Baráth K et al: Neuroradiology of cholesteatomas. AJNR Am J Neuroradiol. 32(2):221-9, 2011
                                          5. Vercruysse JP et al: Magnetic resonance imaging of cholesteatoma: an update. B-ENT. 5(4):233-40, 2009
                                          6. 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
                                          7. 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
                                          8. 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
                                          9. Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
                                          10. Gocmen H et al: Surgical treatment of cholesteatoma in children. Int J Pediatr Otorhinolaryngol. 67(8):867-72, 2003
                                          11. Minor LB: Labyrinthine fistulae: pathobiology and management. Curr Opin Otolaryngol Head Neck Surg. 11(5):340-6, 2003
                                          12. Williams MT et al: Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings. Eur Radiol. 13(1):169-74, 2003
                                          13. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                          14. Yates PD et al: CT scanning of middle ear cholesteatoma: what does the surgeon want to know? Br J Radiol. 75(898):847-52, 2002
                                          15. Soldati D et al: Knowledge about cholesteatoma, from the first description to the modern histopathology. Otol Neurotol. 22(6):723-30, 2001
                                          16. Sade J: Surgical planning of the treatment of cholesteatoma and postoperative follow-up. Ann Otol Rhinol Laryngol. 109(4):372-6, 2000
                                          17. 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
                                          18. Stangerup SE et al: Cholesteatoma in children, predictors and calculation of recurrence rates. Int J Pediatr Otorhinolaryngol. 49 Suppl 1:S69-73, 1999
                                          19. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                          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

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Pars tensa cholesteatoma (PTC)
                                                      • Middle ear (ME)
                                                    • Synonyms

                                                      • Sinus cholesteatoma, due to involvement of sinus tympani
                                                      • Secondary acquired cholesteatoma
                                                    • Definitions

                                                      • Focal accumulation of exfoliated keratin within stratified squamous epithelium at site of perforation or retraction pocket at pars tensa portion of tympanic membrane (TM)
                                                        • "Tense" lower 2/3 of TM

                                                    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. 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
                                                                                  2. Shinnabe A et al: Differences in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas. Eur Arch Otorhinolaryngol. 271(8):2171-5, 2014
                                                                                  3. Más-Estellés F et al: Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas. Radiographics. 32(4):1197-213, 2012
                                                                                  4. Baráth K et al: Neuroradiology of cholesteatomas. AJNR Am J Neuroradiol. 32(2):221-9, 2011
                                                                                  5. Vercruysse JP et al: Magnetic resonance imaging of cholesteatoma: an update. B-ENT. 5(4):233-40, 2009
                                                                                  6. 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
                                                                                  7. 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
                                                                                  8. 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
                                                                                  9. Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
                                                                                  10. Gocmen H et al: Surgical treatment of cholesteatoma in children. Int J Pediatr Otorhinolaryngol. 67(8):867-72, 2003
                                                                                  11. Minor LB: Labyrinthine fistulae: pathobiology and management. Curr Opin Otolaryngol Head Neck Surg. 11(5):340-6, 2003
                                                                                  12. Williams MT et al: Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings. Eur Radiol. 13(1):169-74, 2003
                                                                                  13. Shohet JA et al: The management of pediatric cholesteatoma. Otolaryngol Clin North Am. 35(4):841-51, 2002
                                                                                  14. Yates PD et al: CT scanning of middle ear cholesteatoma: what does the surgeon want to know? Br J Radiol. 75(898):847-52, 2002
                                                                                  15. Soldati D et al: Knowledge about cholesteatoma, from the first description to the modern histopathology. Otol Neurotol. 22(6):723-30, 2001
                                                                                  16. Sade J: Surgical planning of the treatment of cholesteatoma and postoperative follow-up. Ann Otol Rhinol Laryngol. 109(4):372-6, 2000
                                                                                  17. 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
                                                                                  18. Stangerup SE et al: Cholesteatoma in children, predictors and calculation of recurrence rates. Int J Pediatr Otorhinolaryngol. 49 Suppl 1:S69-73, 1999
                                                                                  19. Vartiainen E et al: Long-term results of surgical treatment in different cholesteatoma types. Am J Otol. 14(5):507-11, 1993
                                                                                  20. Swartz JD: Cholesteatomas of the middle ear. Diagnosis, etiology, and complications. Radiol Clin North Am. 22(1):15-35, 1984