Cholesteatoma type otitis media was changed to middle ear cholesteatoma in the 2012 Chinese Medical Association’s Clinical Classification and Surgical Staging Guidelines for Otitis Media. It used to be thought that cholesteatoma type otitis media was the most severe type of chronic suppurative otitis media, but in fact this disease is a growth of squamous epithelial tissue in the middle ear and mastoid, and its generation mechanism, pathology and regression are different from chronic suppurative otitis media. The so-called cholesteatoma is a collection of exfoliated epithelium that grows larger and larger and expands in all directions, thus causing destruction of the adjacent bone and possibly complications in the surrounding organs. Therefore, the treatment of this disease is that surgery should be recommended once diagnosed, and the main purpose of surgery is not to propose high hearing and no abscess, but to prevent complications.
I. Clinical manifestations
1. May be asymptomatic
Cholesteatoma without infection may be asymptomatic in the early stage.
2. Pus in the ear
Middle ear cholesteatoma without infection may have no ear discharge. If it is accompanied by purulent otitis media, there may be pus flowing from the ear, and the amount of pus varies, and the pus often has a special foul odor, and if it is accompanied by sarcoidosis, there may be blood in the pus.
3. Hearing loss
Hearing loss may be the only complaint in cholesteatoma without infection, and in the early stages it is mostly conductive deafness, with varying degrees of severity. In the case of small cholesteatoma in the upper tympanic chamber, the hearing may be basically normal. Even if the auditory bone is partially destroyed, the hearing loss is less severe because the cholesteatoma serves as a bridge between the auditory bones. When the lesion involves the cochlea, the deafness is mixed. In severe cases, total deafness may occur.
4. Tinnitus
Mostly due to cochlear involvement.
Examination
1. Otoscopic examination
Mainly, the tympanic membrane may be inwardly sunken and perforated in the relaxed part, inwardly sunken and thickened in the tense part, or perforated at the upper posterior edge of the tympanic membrane, and grayish white cholesteatoma crust or red granulation tissue polyp tissue may be seen in the tympanic chamber, often accompanied by purulent discharge.
2. Audiological examination
Hearing can be basically normal, or conductive hearing loss, or mixed hearing loss or even sensorineural deafness.
3. Eustachian tube function examination
It can be normal or poor.
4. Imaging
Larger cholesteatoma on mastoid x-ray may show typical bony destruction cavity with dense and neat margins. In recent years, the high-resolution CT scan of temporal bone is widely used, which shows the increased density of tympanic papillae, and may be accompanied by the resorption and destruction of bone, with neat and sclerotic edges, and may have the “eggshell” sign.
Diagnosis
The diagnosis can be confirmed based on clinical manifestations and auxiliary examinations.
Differential diagnosis
It should be differentiated from chronic suppurative otitis media without cholesteatoma.
V. Treatment
The principles of treatment are to eradicate the diseased tissue, prevent complications, and reconstruct the middle ear sound transmission structure. Surgical treatment: The primary goal is to completely remove the lesion and obtain a dry ear if possible. Specific methods: open upper tympanic chamber; closed surgery; open surgery; mastoid radical surgery. The choice of surgery should be based on the extent of the lesion, the function of the eustachian tube, the type and degree of hearing impairment, the presence of complications, and the development of the mastoid process.