When an Ear Infection Is More Serious: Diagnosis, Care of Cholesteatoma

Left untreated, cholesteatoma can erode the affected area, leading to permanent hearing loss, vertigo, tinnitus, tympanic membrane perforation, facial paralysis, meningitis, brain abscess, or even death. There can also be obstruction of the eustachian tube by a lesion that produces tympanic membrane...

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Bibliographic Details
Published inThe Clinical Advisor : For Nurse Practitioners Vol. 27; no. 1; pp. 19 - 22
Main Author Fish, Samantha
Format Trade Publication Article
LanguageEnglish
Published Hawthorne Haymarket Media, Inc 01.04.2024
Subjects
Antibiotics
Congenital diseases
Ear diseases
Eardrum
Hearing loss
Hearing protection
Infections
Magnetic resonance imaging
Meningitis
Pain
Patient assessment
Pediatrics
Primary care
Squamous cell carcinoma
Surgery
Ventilators
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Summary:Left untreated, cholesteatoma can erode the affected area, leading to permanent hearing loss, vertigo, tinnitus, tympanic membrane perforation, facial paralysis, meningitis, brain abscess, or even death. There can also be obstruction of the eustachian tube by a lesion that produces tympanic membrane retraction, middle ear fluid, and conductive hearing loss.1 Congenital cholesteatoma can be located in the anterosuperior quadrant of the middle ear and the postero-superior quadrant.4 This type of cholesteatoma is progressive and destructive; most patients appear asymptomatic, while others experience severe complications such as ossicular destruction, facial paralysis, and base-of-skull complications.3 Primary Acquired Cholesteatoma Primary acquired cholesteatoma is a result of tympanic membrane retraction. Upon otoscope exam, the provider may see dark, foul-smelling, purulent discharge with a sticky earwax texture.8The clinician may also see a white mass or perforated eardrum with retraction (as shown in the Figure).4 Radiologic Examinations Computed tomography (CT) and magnetic resonance imaging (MRI) are the gold standards for preoperative assessment of extension of bone erosion with cholesteatoma. An MRI is beneficial for preoperative diagnosis and evaluating recurrence and residual lesions, and for evaluating the spread of cholesteatoma through the skull base.9-10 An audiogram can assess the eardrum and middle ear, along with the degree of hearing loss from the disease.
ISSN:1524-7317