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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The hallmarks of a cholesteatoma are:

  • smelly (faecal) discharge and chronic drainage
    • often presents as chronic otorrhea unresponsive to antibiotic therapy (1)
  • hearing loss
    • in 90 percent of patients there is conductive hearing loss caused by ossicular erosion (2)

Other symptoms depend on the extent of local expansion. Possible associated clinical features include:

  • vertigo
  • headache
  • facial nerve palsy - caused by pressure
  • cerebral abscess formation
  • cerebellopontine angle syndrome

Otoscopy commonly shows, either:

  • pearly, white, glistening debris occupying a perforation in the tympanic membrane - usually the pars flaccida
  • crusting in the uppermost part of the ear drum - the attic - beneath which lies a cholesteatoma

Tuning fork tests usually show a conductive hearing loss.


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