OtoRhinoLaryngology Portal

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OtoRhinoLaryngology Portal Video Collections

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Congenital Cholesteatoma

Dullness and opacity involving the pars flaccida

and posterosuperior segment of the pars tensa.

Close-up view of the same patient's eardrum. (X - cholesteotoma materials)

White epithelial pearl arising from attic with an intact tympanic membrane.

Congenital Cholesteatoma with Attic Involvement

Visible whitish hue deep to posterior pars tensa secondary to

congenital cholesteatoma which has finally eroded the attic region.

Serial images displayed to demonstrate its clinical progression over times

before surgical intervention undertaken.

Close-up view of keratin flakes.

Primary External Ear Canal Cholesteatoma

                           Pre-aural toilet of the the same patient below.



Cavity involving the floor of cartilaginous auditory meatus filled with keratin (rounded rectangle).  Bone sequestrum was also removed along with the keratin flakes from this crater earlier.  Normal tympanic membrane is seen beyond (TM). 

Secondary External Auditory Meatus Cholesteatoma with False Tympanic Membrane Formation


 A completely obstructed ear canal with a bulging tense membrane.


A close-up view of the above lesion.

Arrow - keratin material filling the ear passage till true ear drum, stars - false tympanic membrane.

Postero-Superior Pars Tensa Retraction

Segmental retraction (outlined) which potentially predisposes to deranged epithelial migration and potential formation of secondary-acquired cholesteatoma.

Pars Tensa Retraction Pocket with Secondary Acquired Cholesteatoma

Cleft palate with resultant eustachian tube dysfunction predisposes to severe atelectasis and retraction pocket formation which complicates

into secondary acquired cholesteatoma.

Cholesteatoma: Bulging of Posterior Eardrum Segment

Postero-marginal Perforation with Polyp in Cholesteatoma


 A similar lesion involving the right ear.   The patient presented with scanty foul-smell ear discharge, dizziness, reduced hearing and headache.  The eardrum appeared severely retracted with granulation seen at the periphery posteriorly and yellow pus in proximity.  Fistula test was found positive!

Attic Granulations in Cholesteatoma

Attic Polyp in Cholesteatoma

               Before ear suctioning                               After ear suctioning


Attic polyp should raise the possibility of underlying cholesteatoma. 

Proper ear toilet should be performed and particular attention paid to attic region.  Cholesteatoma flakes can be seen as cheesy white material.

Attic Retraction Pocket with Trapped Keratin

Arrow - attic retraction pocket, X - trapped keratin, TM - tympanic membrane, L - lateral process of malleus. 

Attic Perforation in Secondary Acquired Cholesteatoma

 An abvious pars flaccida/attic perforation with cholesteatoma lesion seen at the background.



A representative high resolution CT-scan slice showing the site and extend of the cholesteatoma lesion (from a different patient with similar clinical presentation). 

Attic Erosion with Auto-atticotomy due to Cholesteatoma

[TM- tympanic membrane, white dot- umbo]

Cholesteatoma: Unusual Type