ENT (Otorhinolaryngology) · MU Sofia

13. Chronic otitis media - epitympanitis (Cholesteatoma).

Covers epitympanitis with cholesteatoma, the dangerous form of chronic otitis media, from its definition and the acquired and congenital origins of the keratinising sac through to bone erosion and its clinical picture. It then sets out examination and CT findings, surgical versus medical management, intratemporal and intracranial complications, and a table comparing it with mesotympanitis, keratosis obturans, aural polyp and other conditions.

Inside: 5 sections · 3 labelled pictures · 1 table · 15 flashcards · 6 min

Topic 13 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 5 sections, about 762 words (6 min of reading), with 15 flashcards.

In this note

  1. Chronic Otitis Media – Epitympanitis (Cholesteatoma)
  2. Etiopathogenesis
  3. Classification
  4. Clinical Picture
  5. Paraclinical and Radiological Examinations Paraclinical

Chronic Otitis Media – Epitympanitis (Cholesteatoma)

This is the “dangerous type” of chronic otitis media.

1. Definition: Epitympanitis with cholesteatoma is a form of chronic otitis media characterized by a keratinizing squamous epithelial sac (cholesteatoma) located in the epitympanum or pars flaccida margins, producing chronic foul-smelling purulent otorrhea and causing progressive conductive (± sensorineural) hearing loss due to its enzymatic capacity to erode bone.

Bone destruction

High risk of serious complications

Etiopathogenesis

  1. 1. Acquired Cholesteatoma (Most Common):
  • Primary Acquired: Due to retraction pocket of pars flaccida from chronic Eustachian tube dysfunction Negative pressure pulls the TM inward, forming a pocket that collects desquamated skin.
  • Keratin accumulates in the pocket → cholesteatoma formation
  • Secondary Acquired: Develops following a marginal perforation in the pars tensa, where skin from the external auditory canal (EAC) grows inward into the middle ear.
  1. 2. Congenital Cholesteatoma: Keratinizing epithelium trapped inside middle ear during embryogenesis
  • Behind an intact eardrum in children

Risk Factors

  • Chronic ETD (allergy, adenoids, sinusitis)
  • Recurrent acute otitis media
  • Poor ventilation of the epitympanum
  • Cleft palate
  • Down syndrome

Pathogenesis - The trapped, expanding sac of keratin debris acts like a tumor.

  1. 1. Accumulation: Desquamated keratin debris accumulates within the sac.
  2. 2. Destruction: The epithelial lining produces bone-resorbing enzymes (collagenases, osteoclast-activating factors), leading to the destruction of the surrounding bone, including the ossicles, the lateral wall of the mastoid (tegmen mastoideum), and the bony canal for the Facial Nerve (CN VII) and Inner Ear.
  3. 3. Infection: The moist, keratin-filled sac often becomes secondarily infected, leading to chronic discharge and inflammation.

Continue reading free

The whole note, all 5 sections, is free with an AceMed account, with its 15 flashcards. Premium adds flashcard recall, highlights and Ask AI.

Start freeAlready a member? Open the note