# Cholesteatoma - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class HD05.00 - condition scope only, no dose · Middle Ear Cholesteatoma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK448108/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text CHOLESTEATOMA Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class HD05.00 - condition scope only, no dose · Middle Ear Cholesteatoma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK448108/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Painless ear drainage, either ongoing or coming and going, is the textbook presentation - The condition affects only one ear in about 85% of cases - Hearing loss can occur, but how bad it is can be hard to judge because the small ear bones may be disrupted [hearing loss] - Dizziness is a worrying complaint that can mean the ossicles have eroded into the inner ear, forming a fistula [dizziness · fistula] - Facial weakness shows up in roughly 1 to 3.4% of patients [facial weakness] - History-taking should cover whether ear symptoms are one- or two-sided, and any past ear infections treated with antibiotics SIGNS - what you find (5) - On otoscopy the classic finding is a white pearly or yellow mass sitting in a retracted pocket, usually toward the back and top of the eardrum - Foul-smelling white or yellow drainage in the canal can hide the underlying lesion on exam - Suctioning discharge under the microscope can show an eardrum hole, whether the ossicles are intact, and any mastoid bone erosion - Granular polyps seen on exam may be attached to the ossicles or the facial nerve and need careful handling [polyp] - Facial movement is checked and recorded as a standard part of the exam TESTS (8) - Diagnosis rests mainly on history, exam, hearing tests, and imaging - lab work and biopsy are usually not needed - Hearing testing before and after surgery covers air and bone conduction, speech thresholds and discrimination, tympanometry, and reflexes - CT scanning before surgery may be skipped unless the diagnosis or extent is unclear, the anatomy is uncertain, or a birth anomaly such as atresia is suspected - A thin-cut, non-contrast temporal bone CT is the preferred scan for finding bone defects, though it can struggle to tell apart granulation tissue, keratin debris, and fluid - On T2-weighted and high b-value diffusion MRI sequences, the lesion shows up bright - On plain unenhanced T1 MRI, the lesion looks the same brightness as surrounding tissue - MRI is considered a must when there is dural involvement, an abscess, brain herniation into the mastoid, inner-ear or facial nerve inflammation, sinus clot, or meningitis - Pairing temporal bone CT with diffusion MRI can sharpen both sensitivity and specificity of the workup IF NOT THIS - what else fits (2) - Other ear infections to weigh include acute or chronic suppurative otitis media, malignant otitis externa, fluid behind the drum, and tympanosclerosis - Structural and granulomatous mimics include a middle ear bone growth, a perforated eardrum, cholesterol granuloma, granulomatosis with polyangiitis, histiocytosis, tuberculosis-type infection, or rare temporal bone cancer Source StatPearls "Middle Ear Cholesteatoma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult An abnormal skin growth in the middle ear that erodes bone and needs surgical removal; the GP can treat a secondarily infected, discharging ear while arranging ENT referral, but cannot treat the underlying disease. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why An abnormal skin growth in the middle ear that erodes bone and needs surgical removal; the GP can treat a secondarily infected, discharging ear while arranging ENT referral, but cannot treat the underlying disease. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Facial weakness, worsening vertigo or hearing loss, or signs of intracranial spread such as severe headache, fever or neck stiffness: refer urgently. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)