Cholesteatoma is a benign growth of skin in the middle ear and/or mastoid that can lead to infection and more serious problems involving the brain and facial nerve.

Diagnosis for Cholesteatoma

Careful microscopic examination of the eardrum, audiometry, and a CT scan of the temporal bone are all ways to detect cholesteatoma. An audiogram is a hearing test conducted in a sound-proof room by an experienced audiologist. There, the ability to hear various frequencies can be determined.

A CT scan of the temporal bone can oftentimes be helpful. A regular CT scan of the head is not sufficient to clearly see the minute structures within the temporal bone. A detailed study with thin sections through the temporal bone is required. CT scans allow us to get an idea of how extensive the cholesteatoma is. These scans are the equivalent of shining light onto an object and trying to make out what the object is by studying the shadows. These scans are not absolute in telling us all we want to know. Normally, the middle ear and mastoid should appear black on a CT scan. Gray-colored areas may represent fluid, infection, cholesteatoma, or scar tissue from a previous surgery. If there is a very thin lining of skin within the middle ear or mastoid, a CT scan will miss the cholesteatoma entirely. In order to be seen on CT, there has to be a substantial accumulation of dead skin and keratin.