Cholesteatoma (pars flaccida)
Left ear pain and discharge
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Soft tissue density within the the "Prussak's space" and the epitympanum displacing the ossicles medially and eroding the scutum and to less extent the bony ossicles.
CT is the modality of choice for diagnostic assessment of cholesteatomas, due to its ability to elegantly demonstrate the bony anatomy of the temporal bone. Cholesteatomas appear as regions of soft tissue attenuation, exerting mass-effect and resulting in bony erosion.
Findings depend on the part of tympanic membrane the cholesteatoma arises from:
- pars flaccida (82%)
- pars tensa
The following questions should be addressed in a patient with a cholesteatoma: 1
- what is the relationship of the mass to the ossicles?
- is the tegmen tympani intact?
- is there potential for fistula into the membranous labyrinth?
- is the facial nerve canal eroded by the mass?
- is there tissue in the sinus tympani?