MyMedR

Fulltext CongenCongenital cholesteatoma: Different clinical presentation in two casesital cholesteatoma: Different clinical presentation in two cases

Mohd Khairi Md Daud, Suhaili Abdul Jalil

Malays Fam Physician, 2016;11(23):30-32.

MyJurnal

Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be
undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced
hearing or otalgia.

Matched MeSH terms: Cholesteatoma

Fulltext Congenital cholesteatoma: delayed diagnosis and its consequences

Goh BS, Faizah AR, Salina H, Asma A, Saim L

Med J Malaysia, 2010 Sep;65(3):196-8.

PMID: 21939167

This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma.

Matched MeSH terms: Cholesteatoma, Middle Ear/complications; Cholesteatoma, Middle Ear/congenital*; Cholesteatoma, Middle Ear/diagnosis*; Cholesteatoma, Middle Ear/surgery

Fulltext Congenital cholesteatoma presenting with Luc's abscess

Santhi K, Tang IP, Nordin A, Prepageran N

J Surg Case Rep, 2012 Dec 11;2012(12).

PMID: 24968423 DOI: 10.1093/jscr/rjs026

Congenital cholesteatoma (CC) rarely presents with Luc's abscess. As a result of widespread usage of antimicrobial agents, Luc's abscess is hardly encountered in current clinical practice. Herein, we report a case of Luc's abscess as the first presenting symptom in a 5-year-old boy with underlying CC. Patient's clinical findings, radiological investigations and treatment were also discussed.

Matched MeSH terms: Cholesteatoma

Cholesteatoma in an Asian population

Lee ST

Acta Otolaryngol, 1991;111(3):536-41.

PMID: 1887780 DOI: 10.3109/00016489109138380

Two hundred Malaysian patients representing 227 ears with previously untreated cholesteatoma disease were analysed retrospectively in terms of i) type of disease, i.e. primary acquired attic defect or posterior superior retraction pocket and secondary acquired type cholesteatoma; ii) positive history of previous middle ear effusion, atelectasis or grommet insertion; and iii) likelihood of complications as initial presenting feature. The high 47.1% incidence of secondary acquired cholesteatoma disease in our patients contrasts with the predominance of primary acquired cholesteatoma in the Caucasian patient. Correlation of these two disease types with a positive history showed a significant positive association between the primary acquired group and a positive history; and conversely a significant negative association for the secondary acquired type. This supports a role for the retraction theory in primary acquired cholesteatoma but negates this theory in secondary acquired cholesteatoma. Secondary acquired cholesteatoma had a significantly higher (35.5%) complication rate against 15.8% in the primary acquired type (p = 0.001). This fact together with a 47.1% incidence of secondary acquired disease, low otolaryngologist population ratio and patient attitudes to disease account for the high total complication rate of 27.3%.

Matched MeSH terms: Cholesteatoma/complications; Cholesteatoma/etiology; Cholesteatoma/epidemiology*

Fulltext Congenital cholesteatoma: Different clinical presentation in two cases

Abdul Jalil S, Md Daud MK

Malays Fam Physician, 2016;11(2-3):30-32.

PMID: 28461856

INTRODUCTION: Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced hearing or otalgia.

METHOD: Case report.

RESULTS: We report two cases of young ladies with CC who presented with different otological symptoms. The first case complained of recurrent unilateral ear pain while the second case presented with unilateral reduced hearing. Examination of both cases revealed a whitish mass seen behind an intact tympanic membrane. Both cases underwent surgery and histopathological examinations; findings were consistent with cholesteatoma.

CONCLUSION: There are varieties of clinical presentations of CC and the diagnosis is based on clinical findings.

Matched MeSH terms: Cholesteatoma

Epithelial migration on the external ear canal wall in normal and pathologic ears

Revadi G, Prepageran N, Raman R, Sharizal TA

Otol Neurotol, 2011 Apr;32(3):504-7.

PMID: 21307812 DOI: 10.1097/MAO.0b013e31820d97e2

HYPOTHESIS: Epithelial migration on the external auditory canal (EAC) wall is abnormal in ears with keratosis obturans (KO).
BACKGROUND: Earlier studies of epithelial migration have focused on the tympanic membrane with scattered information available for epithelial migration on canal walls. This study was undertaken to observe the epithelial migration on the EAC wall in normal ears and in ears with KO.
METHODS: Twenty-five subjects with normal ears and 4 with KO were recruited for the study. Colored ink dots were placed around the tympanic annulus at the 12, 3, 6, and 9 o'clock positions. Migration patterns and the rate of travel of these ink dots were examined and photographed until the ink dots reached the bony cartilaginous junction.
RESULTS: Fifteen healthy subjects and 1 with bilateral KO completed the study. The ink dots migrated laterally, with a rate of migration in normal ears between 42 and 205 μm/d. The mean rates for each quadrant, measured clockwise from the 12 o'clock position, were 104.93, 89.80, 72.67, and 109.93 μm/d, respectively. The pathologic ears exhibited a rate between 88 and 140 μm/d, and at approximately 4 to 12 weeks after ink application, areas of abnormal desquamation were apparent at the inferior quadrant, leading to a halt in the migration of the ink dot once it reached these sites.
CONCLUSION: Epithelial migration occurred in an almost linear pattern in all quadrants, but the speed of migration was relatively slower in the anterior and inferior quadrants of a normal EAC. In the single KO patient, there were areas of normal migration and areas of abnormal keratin resurfacing at the inferior quadrant, which interfered with the migration of ink dots.

Matched MeSH terms: Cholesteatoma/pathology*

A unilateral mesenchymal disorder of the head

Raman R, Kumar V, Arianayagam S, Peh SC

J Craniomaxillofac Surg, 1989 Apr;17(3):143-5.

PMID: 2708537

A hitherto undescribed group of lesions consisting of cystic bony lesions, exostosis, fibromatous lesion, unilateral tonsillar hypertrophy, epidermoid cyst (cholesteatoma) and hyperplasia of the mandible confined to the left side of the face is reported. The case may represent a variant of the Proteus syndrome.

Matched MeSH terms: Cholesteatoma*

Fulltext Congenital or acquired? A case report of extensive congenital cholesteatoma

Roslenda, A.R., Asma, A., Igbal, F.R.W., Jeevanan, J.

Medicine & Health, 2010;5(2):103-107.

MyJurnal

Congenital cholesteatoma (CC) is rare clinical condition and It is known as a pearly white mass medial to an intact tympanic membrane. In this case report, we describe a 6-year-old boy who presented with a one year history of left ear discomfort, reduced hearing, followed by ear discharge two months prior to admission. Otoscopic examination revealed a large attic perforation. Radiological investigation showed extensive cholesteatoma in the mastoid, mesotympanum and epitympanum with destruction of the ossicles including the stapes footplate. He underwent radical mastoidectomy in view of extensive cholesteatoma with tympanoplasty type V. In this case report, the classification, treatment and theories related to CC are discussed.

Matched MeSH terms: Cholesteatoma

Fulltext Cholesterol granuloma in a post-mastoidectomy for cholesteatoma

Mohd Khairi MD, Ramiza Ramza R

Med J Malaysia, 2012 Apr;67(2):217-8.

PMID: 22822649 MyJurnal

Cholesterol granuloma is a histological term used to describe the foreign body reaction towards cholesterol crystals causing granuloma. We report a case of cholesterol granuloma in a patient who presented with a mass in her ear after 6 years of mastoidectomy. The diagnosis has been confirmed by MRI and postoperative findings. The difference between cholesterol granuloma and the other entities especially cholesteatoma and meningoencephalic herniation must be made in view of its implications and surgical management of each lesion.

Matched MeSH terms: Cholesteatoma/pathology; Cholesteatoma/surgery*

A giant mastoid cholesteatoma with posterior cranial extension causing mass effect and obstructive hydrocephalus

Sabir BI, Rahmat K, Bux SI, Rajagopal NS, Looi LM, Sia SF

Clin Neurol Neurosurg, 2013 Oct;115(10):2192-6.

PMID: 23791432 DOI: 10.1016/j.clineuro.2013.05.023

Matched MeSH terms: Cholesteatoma, Middle Ear/complications; Cholesteatoma, Middle Ear/pathology; Cholesteatoma, Middle Ear/surgery*

Fulltext Temporal bone carcinoma: a case report

Noorizan Y, Asma A

Med J Malaysia, 2010 Jun;65(2):162-4.

PMID: 23756808 MyJurnal

Temporal bone carcinoma may masquerade as an infective process causing late diagnosis. A delay in treatment as a result of missed diagnosis would carry a poor prognosis as the disease progresses to an advanced stage. We present a lady with history of chronic otorrhea, who developed left sided otalgia associated with hearing loss in her sixth decade. She underwent surgery which revealed left mastoiditis and cholesteatoma. After a year, she had a mass in her left ear and pus discharge which was initially treated as an infection. The biopsy of the mass was proven to be squamous cell carcinoma. High index of suspicion is necessary when encountering patients presenting with a mass in the ear canal with prior history of chronic otorrhea or cholesteatoma. Proper tissue biopsy is crucial. Early referral to tertiary centre is required for further management of the patient.

Matched MeSH terms: Cholesteatoma

Fulltext Mastoiditis in Kelantan

Elango S, Than T

Med J Malaysia, 1995 Sep;50(3):233-6.

PMID: 8926900

Chronic mastoiditis and subperiosteal abscess are rarely seen nowadays in most countries. Thirty-four cases of mastoiditis were reviewed to find out the prevalence of chronic mastoiditis in the east coast of Malaysia. Twenty (58.82%) of these cases were a sequelae of chronic suppurative otitis media with cholesteatoma. All the patients with chronic mastoiditis were more than six years old. Forty-five percent of cases with chronic mastoiditis had a well pneumatized mastoid air cell on the unaffected side. The occurrence of chronic mastoiditis or cholesteatoma in a well pneumatized mastoid is not really as rare as was thought to be. X-ray of the mastoids is very useful in diagnosing patients with chronic mastoiditis and cholesteatoma. Mastoiditis is uncommon in adults and whenever a case is seen, an underlying pathology like cholesteatoma should be suspected.

Matched MeSH terms: Cholesteatoma, Middle Ear/complications

Long-term status of middle-ear aeration post canal wall down mastoidectomy

Ezulia T, Goh BS, Saim L

J Laryngol Otol, 2019 Aug;133(8):662-667.

PMID: 31267884 DOI: 10.1017/S0022215119001385

BACKGROUND: Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.

OBJECTIVE: This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.

METHODS: All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.

RESULTS: Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.

CONCLUSION: After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

Matched MeSH terms: Cholesteatoma, Middle Ear/surgery*

Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review

Mazita A, Zabri M, Aneeza WH, Asma A, Saim L

J Laryngol Otol, 2011 Nov;125(11):1116-20.

PMID: 21846418 DOI: 10.1017/S0022215111002052

To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.

Matched MeSH terms: Cholesteatoma/complications; Cholesteatoma/epidemiology; Cholesteatoma/radiography; Cholesteatoma/surgery*

Epithelial migration in open mastoidectomy cavities

Ong CA, Prepageran N, Godbole S, Raman R

Asian J Surg, 2007 Jan;30(1):57-9.

PMID: 17337373

To study the rate and pattern of epithelial migration in 18 dry, open mastoidectomy cavities.

Matched MeSH terms: Cholesteatoma, Middle Ear

Intracranial Complications of Chronic Otitis Media: Why Does It Still Occur?

Gendeh HS, Abdullah AB, Goh BS, Hashim ND

Ear Nose Throat J, 2019 Aug;98(7):416-419.

PMID: 31018687 DOI: 10.1177/0145561319840166

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.

Matched MeSH terms: Cholesteatoma

Fulltext Acute mastoid abscess secondary to partially treated upper respiratory tract infection: a case report

Halimuddin, S., Asma, A.

Medicine & Health, 2010;5(1):41-44.

MyJurnal

Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.

Matched MeSH terms: Cholesteatoma

Fulltext Clinical characteristic of vertigo in children

Rosdan S, Basheer L, Mohd Khairi MD

Med J Malaysia, 2015 Aug;70(4):220-3.

PMID: 26358017 MyJurnal

Objective: To review the clinical characteristic of vertigo in children.
Method: A retrospective observational study was done on children who presented to a specialised vertigo clinic over period of six years. The patients’ case notes were retrieved from the medical record unit and reviewed. All patients were seen by an otologist who thoroughly took down history, completed ear, nose, throat and neurological examination.
Result: Seven different causes were identified in 21 patients (86%) while no diagnosis was reached in three patients (12.5%). The most common cause of giddiness was childhood paroxysmal vertigo (33%) followed by benign paroxysmal positional vertigo (16.6%) and sensorineural hearing loss (12.5%). Other causes include chronic suppurative otitis media and anxiety disorder each accounting for 8.3%, one case of cholesteatoma and another case of ear wax each accounting for 4.1%.
Conclusion: It is not uncommon for the children to be affected by vertigo. Management of vertigo in children should include a detailed history, clinical examination, audiological and neurological evaluation. Imaging should be performed in selected patients. The main cause of vertigo in our series is CPV. The outcome of most of the patients is good.

Matched MeSH terms: Cholesteatoma

Fulltext Otogenic Brain Abscess: A Retrospective Study of 10 Patients and Review of The iterature

Asma, A., Hazim, M.Y.S., Marina, M.B., Azizi, A.B., Suraya, A., Norlaili, M.T., et al.

Medicine & Health, 2007;2(2):133-138.

MyJurnal

Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The aim of this study was to describe the clinical profile, treatment and surgical outcome of patients presenting with otogenic brain abscess. The medical record of patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with otogenic brain abscess were retrospectively analyzed from January 1997-January 2006. Within this eriod we had approximately 10,800 of follow up cases of chronic otitis media (COM) in our clinic. Ten patients (2 females, 8 males) with an average age of 42 (age range 11 to 69 years) were identified with otogenic brain abscess and included in this study. The mean follow-up period was 14 months. All patients had cholesteatoma. All patients had a history of chronic ear discharge, headache, otalgia and fever. Six of the 10 patients had cerebellar abscess and 4 had temporal lobe abscess. Cerebellar signs were present in 3 patients All the patients were treated with broad-spectrum antibiotics. In 5 patients, mastoid exploration was the primary surgical treatment and the brain abscesses were treated conservatively. In the other 5 patients, craniotomy and drainage were performed followed by mastoid exploration when their neurological conditions had stabilized. All our patients had uneventful recovery. There were no permanent cerebellar signs during the follow up and no mortality reported in our series. In this series we demonstrated that early diagnosis and proper treatment of otogenic abscess leads to good neurological outcome.

Matched MeSH terms: Cholesteatoma

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