Acquired middle ear cholesteatoma
Left epitympanic membrane retraction on clinical examination
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Small (2-3mm) soft tissue mass in the space of Prussak adjacent to the neck of the malleus at the site of tympnaic membrane retraction on clinical examination. When compared with the normal right side, the tip of the scutum is minimally eroded.
A small defect in the epitympanum (pars flaccida) allows skin from the external canal to grow into the middle ear at the scutum and to accumulate in the Prussak space causing erosion to the scutum tip at its junction with the tympanic membrane (and the adjacent malleus).