Diagnosis of Cholesteatoma
Diagnosis of cholesteatoma relies on careful clinical evaluation, supported by hearing tests and imaging. Because a cholesteatoma can silently erode bone and spread into surrounding structures, early detection is crucial to avoid permanent damage. Many patients present with long-standing symptoms like ear discharge or hearing loss, which can be overlooked or misdiagnosed without proper assessment.
The process begins with a full medical history. The ENT specialist will ask about chronic ear infections, surgeries like grommet insertion, childhood ear disease, or symptoms like ear discharge, hearing changes, dizziness, or facial weakness. The history helps differentiate cholesteatoma from common middle ear infections or conditions like otitis media with effusion.
The next step is a detailed otoscopic examination. Using a handheld otoscope or, preferably, a microscope or endoscope, the clinician inspects the ear canal and eardrum. Signs suggestive of cholesteatoma include:
- A white mass behind the eardrum
- Retraction pockets, particularly in the upper back quadrant of the eardrum
- Perforations with active discharge
- Granulation tissue or keratin debris
- Poor visibility of the ossicles
Diagnosis of Cholesteatoma
Advanced examination with otoendoscopy provides a clearer and more magnified view of hidden recesses, making it easier to detect small or early cholesteatomas.
An audiogram or hearing test is essential to assess the extent of hearing loss. Most patients show conductive hearing loss, where sound cannot pass effectively through the middle ear. In some cases, particularly if the inner ear is involved, there may also be sensorineural hearing loss. Speech discrimination scores may also be reduced.
Tympanometry is a valuable test that measures eardrum compliance and middle ear pressure. It can confirm eustachian tube dysfunction, fluid build-up, or abnormal movement of the tympanic membrane.
High-resolution CT scanning of the temporal bones is the gold standard for evaluating the extent of the disease. It provides detailed images of:
- Bone erosion
- Involvement of the ossicles, mastoid, or semicircular canals
- Presence of intracranial extension
- Air cell destruction in the mastoid
- Facial nerve canal erosion
In specific cases, an MRI may be requested to identify soft tissue extension or complications like brain abscess, meningitis, or sigmoid sinus thrombosis. Post-operatively, MRI with diffusion-weighted imaging is also used to monitor recurrence.
Diagnosis of Cholesteatoma
In infected cases, a microbial culture may be taken to guide antibiotic therapy. However, bacterial identification does not confirm or exclude the presence of a cholesteatoma.
A confirmed diagnosis of cholesteatoma warrants surgical referral. Early identification allows for conservative and less extensive surgery, while delayed diagnosis may result in more complex and high-risk procedures.
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