Cholesteatoma is a non-cancerous growth of squamous epithelium that is 'trapped' within the skull base causing local destruction. It is most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.

PC

Main features

• foul-smelling, non-resolving discharge
• hearing loss

Other features are determined by local invasion:

• vertigo
• facial nerve palsy
• cerebellopontine angle syndrome

Investigation

• Otoscopy
  • 'attic crust' - seen in the uppermost part of the ear drum
• High resolution CT scan of the petrous temporal bone

Management

• patients are referred to ENT for consideration of surgical removal