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.
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.
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).
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.
Segmental retraction (outlined) which potentially predisposes to deranged epithelial migration and potential formation of secondary-acquired cholesteatoma.
Cleft palate with resultant eustachian tube dysfunction predisposes to severe atelectasis and retraction pocket formation which complicates
into secondary acquired 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!
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.
Arrow - attic retraction pocket, X - trapped keratin, TM - tympanic membrane, L - lateral process of malleus.
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).