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Thursday, February 2, 2017

A 35 Year Old Patient With Progressive Hearing Loss

A 35-year-old presents with unilateral hearing loss that has been gradual but progressive over the last 6 months. Otoscopy reveals a Cholesteatoma.



Appropriate treatment of the above condition consists of
A) Prolonged antibiotics for up to 4 weeks
B) Decongestant and antihistamine administration
C) Corticosteroid treatment for 2 weeks
D) Hearing aid amplification
E) Tympanomastoidectomy

Answer:
The answer is E. (Tympanomastoidectomy)

Discussion: Cholesteatoma is a growth of desquamated, stratified, squamous epithelium within the middle ear space. The condition occurs when keratin desquamates from the epithelial lining of the sac and gradually enlarges with eventual erosion of the ossicular chain, mastoid bowl, and external auditory canal. The development of a cholesteatoma typically occurs after a retraction pocket has formed in the posterior/superior quadrant of the ear, often as a result of chronic eustachian tube dysfunction. It may also occur after tympanic membrane (TM) trauma, such as a traumatic, inflammatory, or iatrogenic perforation. Without treatment, cholesteatomas may erode the tegmen
tympani (the bony covering of the middle fossa), the sigmoid sinus, or even the inner ear. As a result, untreated cholesteatomas can result in lateral sinus thrombosis, sepsis, brain abscess, sensorineural hearing loss, vertigo, disequilibrium, facial paralysis, and even death.
Treatment is surgical, usually involving a tympanomastoidectomy.

3 comments:

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