Contemporary clinical features of Cholesteatoma

Chronic Otitis media with Cholesteatoma is a destructive lesion of middle ear and mastoid region. In a series of 122 patients with established diagnosis of atticoantral disease, clinical characteristics of consecutive 74 patients with cholesteatoma otitis media were compared with 48 patients with chronic otitis media without cholesteatoma (Controls).The patients answered a questionnaire, preoperative and perioperative clinical observations were recorded. There were no specific presenting symptoms or clinical signs that could distinguished the cholesteatoma patients. However, these patients had a significantly higher incidence (32%) of previous middle ear surgery than the control patients (18%). Aural bleeding was reported in higher number in controlled cases (8.5%) as compare to cholesteatoma cases (1.3%). Pars flaccida perforation was noted in 94 % (80% isolated) in cholesteatoma patients. Extracranial complications e.g. mastoid abscess, postaural fistula, mastoiditis and otitis externa was note in 6.7% and 4% respectively in cholesteatoma and control group. The percentage of labyrinthitis and facial nerve affection was 11% and 4.1% in cholesteatoma cases respectively against 6% and 2% in control group. The cholesteatoma was not evident until the time of surgical exploration in as many as 28% of cases. Therefore surgical exploration appears to be the reliable and safest way to identify cholesteatoma.