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

• Published in: The Clinical Advisor : For Nurse Practitioners Vol. 27; no. 1; pp. 19 - 22
• Main Author: Fish, Samantha
• Format: Trade Publication Article
• Language: English
• 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
• ISSN: 1524-7317

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.