CHOLESTEATOMA = KERATOMA
THE PRESENCE OF KERITINIZING SQUAMOUS EPITHELIUM FOUND TO BE INVADING THE SPACES OF THE TEMPORAL BONE.
CONTAINS ALL LAYERS OF THE EXT SKIN (MATRIX) AND HAS A CENTRAL MASS OF KERATIN DEBRIS
GT FORMS BETWEEN THE CONTACT POINTS OF THE MATRIX AND BONE
1)LOCAL PRESSURE AND 2)ENZYMES LEAD TO ISCHEMIC NECROSIS AND DISSOLUTION OF BONE —CAN BECOME SECONDARILY INFECTED AND CAUSE ACCELERATED EROSION
TOYNBEE’S LAW = MASTOID ITIS—CAN LEAD TO LAT SINUS THROMBOSIS AND CEREBELLAR INFXN WHERE AS ATTIC CHOLESTEATOMA ALONE CAN AFFECT THE CEREBRUM ALONE FIRST
MIDDLE EAR
EPITYMPANIC MUCOSAL FOLDS AND COMPARTMENTALIZATION PROPOGATE PREFORMED PATTERNS OF SPREAD
POST EPITYMPANUM—OFTEN TENDS TO GROW SUP TO THE OSSICLES THROUGH THE ANTRUM AND INTO THE MASTOID (ATTIC CHOLESTEATOMA)
CAN ALSO ENTER THE POST SPACE OF VON TROELSTSCH AND MESOTYMPANUM WHERE IT BECOMES ASSOC WITH THE OSSICLES, RW, FACIAL RECESS AND SINUS TYMPANI
ANT EPILTYMPANUM—-ANT SPACE OF VON TROELSCH AND SUPRATUBAL CELLS
CONGENITAL
PERSISTENT EPIDERMOID FORMATION
PRIMARILY (2/3) ANT/SUP MESOTYMPANUM
RARE—SEEN AS A WHITE MASS
MALE 3:1 FEMALE
USUALL PRESENT 4-5 YEARS OF AGE
DIFFERING THEORIES ON ETIOLOGY—32ND WEEK PERSISTENT HETEROTOPIC REST—ANALOGOUS TO DERMOIDS
ENCAPSULATED = BETTER Px—“CLOSED TYPE”
RECENTLY DESIGNATED AS “OPEN TYPE” IN WHICH THE MATRIX FORMS A SHEET RATHER THAN A CYST AND A “CLOSED TYPE” WHICH FORMS AN ENCAPSULATED CYST.
AQUIRED
PRIMARY/AURAL
DEV FROM DEEP RP(ETD—NEG PRESSURE)—-PARS FLACCIDA IN ADULTS AND PARS TENSA IN CHILDREN
SECONDARY
DEV FROM EPITHELIAL INGROWTH FROM A MARGINAL PERF (DEFECT INVOLVES FIBROUS ANNULUS)
COMMON—-IATROGENIC WOULD BE A SUBTYPE OF THIS
PERIMATRIX=FIBROUS TISSUE AND MATRIX=STRAT SQUAM EP. AND CONTAINING HORNY LAMELLAE IN CYSTIC LUMEN
EPITHELIAL EPIDERMOID CYST
NOT ALWAYS CONNECTED WITH CHRONIC INFLAMMATION
CT = ISODENSE TO CSF, NO ENHANCEMENT
MRI = T1 LOW INTENSITY
T2 HIGH INTENSITY
NO AREAS OF SIGNAL VOID
NO ENHANCEMENT WITH GAD
ASSOC. WITH CHRONIC EAR Dz, SCUTAL EROSION, ATELECTASIS
CONTRALATERAL APEX NOT WELL PNEUMATIZED
Rx: COMPLETE SURGICAL EXCISION
EAC
KERATOSIS OBTURANS
BILAT
OFTEN CAUSED BY EAC OBST., OSTEOMAS, CANAL STENOSIS, HARD CERUMIN IMPACTIONS
LINKED WITH IMMOTILE CILIA SYNDROME—BRONCHTIECTASIS, COPD, SINUSITIS
RARE
YOUNG
PAINFUL TO REMOVE
CAUSES COMPENSATORY CANAL WIDENING DUE TO ACCUMULATION OF DEPBRIS
Rx: PERIODIC CLEANING AND EXT EAR CARES
CANAL CHOLESTEATOMA
BONEY EAC ERODED—DEAD SEQUESTERED BONE—MUST R/O SCCA OF THE EAC
UNILAT
OTTORRHEA
OLDER PTS
FOCALIZED OSTEITIC BONE
PRIMARILY OCCUR AT THE POST/INF EAC
CHOLESTEROL GRANULOMA
RARE
PETROUS APEX (PERITUBAL CELLS)
FIBROUS TISSUE WITH CHOLESTEROL FROM RBC MEMBRANES-LEAVES CLEFTS FROM PREP,  NUMEROUS INFLAMMATORY CELLS AND F. B. GIANT CELLS
REACTIVE F.B. GRANULOMA
ALMOST ALWAS REPRESENTS A FOCAL RESPONSE TO CHRONIC INFECTION—HEMORRAGIC BREAKDOWN OF FAT CONTAINING INFLAMMATORY CELLS—-SUBSEQUENT CRYSTALIZATION OF CHOLESTEROL ACTS AS A F.B.
CT=ISODENSE TO BRAIN, NO ENHANCEMENT
MRI=T1 HIGH INTENSITY
T2 HIGH INTENSITY
+ AREAS OF SIGNAL VOID
NO ENHANCEMENT WITH GAD
CONTRALATERAL APEX WELL PNEUMATIZED
CHOLESTEROL GRANULOMA CYST
A NON-SPECIFIC F.B. TYPE RXN
DESCRIBED BY SHAMBAGH ‘29
“IDIOPATHIC HEMOTYMPANUM” AS PRECURSOR TO MIDDLE EAR CHOLESTEROL GRANULOMA–”THE BLUE EAR DRUM”
Rx: MYRINGOTOMY-SUCTION-PET
REPAIRATIVE GRANULOMA (SCHUETNECK)
POST STAPEDECTOMY
GRANULOMA IN POST MESO-TYMPANUM
SEVERE OTOLOGIC Sx
MUST RETURN TO OR IMMEDIATELY AND REMOVE
REPAIRATIVE GRANULOMA(1-2%)—-1-6 WEEKS POST OP(USUALLY 1 WEEK)—-GET A VERY SIG MIXED HL WITH POOR SDS OUT OF PROPORTION WITH THE PTA HL
OFTEN SUDDEN ONSET OF VERTIGO, TINNITUS AND SNHL–MORE COMMON WITH STAPEDECTOMY VS STAPEDOTOMY
THICKENED TM, DEEP RED/GREY HUGHE HIGH IN THE POST SUP QUADRANT OF THE TM—-GT—MUST GO FOR IMMEDIATE SURGERY
POSSIBLY RELATED TO TALC OR BAD BATCH OF GELFOAM