cholesteatoma of attic

Definition and Characteristics

A cholesteatoma of the attic, also known as an attic cholesteatoma, is a type of skin cyst that develops in the attic region of the middle ear. The attic is the area above the eardrum, just below the tympanic membrane's superior portion.

• Definition: An epidermoid cyst found in the attic, differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma [5].
• Characteristics: Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities, such as metaplastic islands of the mucosa [5].

Symptoms and Diagnosis

The hallmark symptom of an attic cholesteatoma is a defect of the superior portion of the tympanic membrane with bone erosion. The center of the defect usually contains stratified squamous epithelium and keratin debris [8]. Other symptoms may include:

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Common Signs and Symptoms of Cholesteatoma in the Attic

A cholesteatoma in the attic, also known as the epitympanic recess, can cause a range of symptoms. While some people may not experience any noticeable signs, others may exhibit the following:

• Hearing loss: A gradual decline in hearing, particularly in the affected ear, is a common symptom of cholesteatoma in the attic [10].
• Ear drainage: Persistent or recurrent discharge from the ear, which can be smelly and watery, is another hallmark sign of this condition [3].
• Crust formation: A crust may form over the eardrum, indicating the presence of a cholesteatoma in the attic [5].
• Perforation: In some cases, a perforation of the eardrum may occur, allowing the discharge to drain out [5].

It's essential to note that these symptoms can be subtle and may not always be immediately apparent. If left untreated, complications such as dizziness, loss of balance, and rare brain infections or clots can develop [13]. Regular check-ups with an otolaryngologist (ENT specialist) are crucial for early detection and treatment.

References:

[3] Symptoms of cholesteatoma. [5] Cholesteatoma Signs and Symptoms. [10] Learn about its causes, symptoms, diagnosis, and treatment. [13] Symptoms of a cholesteatoma include hearing loss and persistent or recurrent ear drainage.

Diagnostic Tests for Cholesteatoma of Attic

Cholesteatoma of the attic, a type of middle ear condition, requires accurate diagnosis to determine the extent of the disease and plan effective treatment. The following diagnostic tests are commonly used to diagnose cholesteatoma of the attic:

• Otoscopic examination: A thorough visual inspection of the ear canal and eardrum using an otoscope is essential for diagnosing cholesteatoma of the attic (10, 8). This test can reveal a retraction pocket or white mass behind the intact tympanic membrane.
• Computed Tomography (CT) scan: A CT scan of the temporal bone is often ordered to evaluate the extent of the disease and assess any potential complications (1, 7). This imaging test provides detailed information about the middle ear structures and surrounding bones.
• Magnetic Resonance Imaging (MRI): An MRI may be beneficial for preoperative diagnosis, evaluating recurrence, and assessing the spread of cholesteatoma through the skull base (11).
• Pure tone audiogram: A hearing test is performed to assess the level of hearing loss in the affected ear.
• Tympanometry test: This test evaluates the function of the middle ear system.

These diagnostic tests help healthcare professionals accurately diagnose cholesteatoma of the attic and develop an effective treatment plan.

Medical Therapy for Attic Cholesteatoma

While surgical removal is the primary treatment for cholesteatoma, medical therapy can play a supportive role in managing the condition.

• Topical antibiotics: Topical antibiotics are often used to surround the cholesteatoma and suppress infection. This can help reduce acute symptoms preoperatively [4].
• Systemic antibiotics: In some cases, systemic antibiotics may be prescribed to treat coexistent infections.
• Adjunctive treatment: Adjunctive topical antimicrobial treatment may be used to help reduce acute symptoms preoperatively, but it is not a substitute for surgical removal.

Limitations of Medical Therapy

It's essential to note that medical therapy alone cannot cure cholesteatoma. Surgical treatment is necessary to remove the accumulated squamous epithelium and keratin debris [3].

• No definitive cure: Any medical treatment cannot provide a definitive cure for attic cholesteatoma, as it requires surgical removal of the affected tissue [5].
• Suppressive therapy: Medical therapy can only suppress symptoms and infection, but it does not address the underlying condition.

Conclusion

While medical therapy has its place in managing attic cholesteatoma, it is essential to emphasize that surgical removal remains the primary treatment for this condition. Topical antibiotics and systemic antibiotics may be used as adjunctive treatments to manage symptoms and coexistent infections, but they should not delay or replace surgical intervention.

References:

[3] Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. [4] Topical antibiotics often surround the cholesteatoma, suppress infection, and penetrate a few millimeters toward its center. [5] Any medical treatment cannot cure it. Surgical treatment is necessary to treat this condition.

When evaluating a patient with suspected middle ear cholesteatoma, it is essential to consider a range of differential diagnoses, as these conditions can present with similar symptoms, such as hearing loss, ear discharge, and chronic ear infections.

Possible Differential Diagnoses:

• Acute Otitis Media
• Chronic Suppurative Otitis Media
• Malignant Otitis Externa
• Otitis Media With Effusion

These conditions can present with similar symptoms to cholesteatoma, making it crucial to consider them in the differential diagnosis.

Key Points:

• Cholesteatoma is a type of skin cyst that occurs in the middle ear and mastoid.
• It can be benign but may enlarge and invade adjacent bone.
• Diagnosis is clinical based on history and otoscopic findings.
• No laboratory tests or biopsies are generally necessary for the diagnosis of cholesteatoma.

References:

• Sudhoff H, Tos M. Pathogenesis of attic cholesteatoma: clinical and immunohistochemical support for ...
• "Pars flaccida (attic) cholesteatomas" (Fig 4A)

Citations: 1. [1] - When evaluating a patient with suspected middle ear cholesteatoma, it is essential to consider a range of differential diagnoses... 2. [3] - Cholesteatoma is a type of skin cyst that occurs in the middle ear and mastoid. 3. [6] - Diagnosis is clinical based on history and otoscopic findings. 4. [7] - No laboratory tests or biopsies are generally necessary for the diagnosis of cholesteatoma.