What is a middle ear cholesteatoma? Cholesteatoma of the middle ear is a neoplastic lesion formed by the accumulation of epithelium in the middle ear. Although benign, it has characteristics similar to a malignant tumor and can easily damage the surrounding bone and cause intracranial and extracranial complications, such as brain abscess, meningitis, and facial paralysis. What types of middle ear cholesteatoma are there? Congenital cholesteatoma: This is caused by abnormal embryonic development. Acquired primary cholesteatoma: A cholesteatoma without a history of purulent otitis media. Acquired secondary cholesteatoma: Cholesteatoma secondary to chronic suppurative otitis media and secretory otitis media. What are the clinical manifestations of middle ear cholesteatoma? The most common manifestations are recurrent pus flow from the external auditory canal, hearing loss, tinnitus, and in some patients, external auditory meatus, vertigo, facial palsy, and even the development of intracranial complications. On examination, a marginal perforation of the posterior superior tympanic membrane in the relaxed or tense part of the tympanic membrane is seen. Through the perforation, scaly or pea-like amorphous material with a strange odor is visible, and some patients have bone destruction in the posterior wall of the external auditory canal or the lateral wall of the superior tympanic chamber. How is middle ear cholesteatoma diagnosed? In most cases of middle ear cholesteatoma, the diagnosis can be made by examination and imaging. What tests are needed for middle ear cholesteatoma? Pure tone audiometry: To understand hearing and to help determine if there is damage to the inner ear. High-resolution CT of the temporal bone: to detect subtle bone destruction. MRI is required when the nature of the lesion is difficult to determine or when there may be: dural invasion, epidural or subdural abscess, intramural meningeal brain bulge, significant inflammation of the membranous vagus or facial nerve, meningitis How is middle ear cholesteatoma treated? Cholesteatoma of the middle ear tends to destroy important surrounding structures and is difficult to remove with medication, so the best treatment is surgery. What are the goals and principles of middle ear cholesteatoma surgery? The primary goal of cholesteatoma surgery is to completely remove the lesion and reconstruct the middle ear sound transmission structures in one or two stages based on the complete removal of the lesion, with the surgical principles of avoiding complications and preventing recurrence. What are the methods of middle ear cholesteatoma surgery? The surgical methods are divided into microscopic surgery and endoscopic surgery. Traditional surgical methods are performed using a microscope, and in recent years endoscopic surgery has become more and more preferred by patients because of its obvious advantages. Microscopic surgery: There are two types of surgery: Endoprosthetic mastoidectomy: The posterior wall of the external ear canal is preserved and the middle ear cholesteatoma and mastoid are removed. Open mastoidectomy: Without preserving the posterior wall of the ear canal, the middle ear cholesteatoma and mastoid are completely removed, and the chance of cholesteatoma recurrence and residual is less than 7%. Endoscopic surgery: Endoscopic cholesteatoma surgery has made rapid progress in the last decade. Endoscopic middle ear cholesteatoma surgery can preserve the normal external auditory canal and mastoid, and normal bathing and swimming can be done after surgery. Statistical results show that the residual rate of cholesteatoma at 2 years after surgery is 6.2%, and the recurrence rate is 3.1%. In addition, endoscopic middle ear cholesteatoma surgery has no obvious external incisions, avoiding postauricular scarring and incisional numbness, short hospital stay, and greatly reduced postoperative return for review, making it the best choice for small to medium-sized cholesteatomas at present. However, it should be noted that middle ear cholesteatomas with extensive involvement of the mastoid process take longer and have less obvious advantages using endoscopic surgery, and it is still necessary to avoid water in the ear after surgery. Therefore, early treatment of middle ear cholesteatoma to avoid involvement of the mastoid process is the best approach when ear discomfort is detected.