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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team


  • are skin or stratified keratinising squamous epithelium growing in the middle ear (1)
  • they are a greasy-looking mass or accumulation of debris that is seen in a retraction pocket or perforation.(2)
  • they often take the form of a cyst or pouch that sheds layers of old skin (3)

  • divided into two types (1):
    • congenital
      • presents as a pearly white mass located behind an intact tympanic membrane
    • acquired.
      • results from a retracted or perforated tympanic membrane with an ingrowth of epithelium

  • aetiology :
    • the cause is unknown
    • it may result from blockage of the Eustachian tube producing a chronic negative pressure in the middle ear which would cause the tympanic membrane to be sucked inwards as a retraction pocket
    • usually, the pars flaccida is indrawn but any thin part of the pars tensa may be involved.
    • the pockets gradually expand as the skin dequamates. Invariably, they become infected and smelly

  • a cholesteatoma is potentially very dangerous because local expansion may result in damage to adjacent vital structures such as dura, lateral sinus, facial nerve and the semicircular canal


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