What this deck covers
Cholesteatoma in ten clinical teaching cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.
Diagnoses and management options tested
Across the ten cases you are asked to choose between options such as: Acute otitis media with spontaneous perforation, External otitis media, Cerumen impaction with secondary infection, Congenital maldevelopment of the tympanic membrane, Congenital cholesteatoma, Secondary acquired cholesteatoma from occult perforation, Cholesteatoma from chronic Eustachian tube dysfunction, Acute otitis media with mastoiditis, Cerumen impaction causing pressure on facial nerve, Labyrinthine fistula with facial nerve erosion, Sudden sensorineural hearing loss from viral infection, Magnetic resonance imaging with diffusion-weighted imaging, High-resolution computed tomography without contrast, Conventional radiographs of the temporal bone, Ultrasound of the middle ear, Canal wall down mastoidectomy with large meatoplasty, Myringoplasty with topical antibiotic therapy, Cholesteatoma with early ossicular involvement, Chronic otitis media with perforation, Two-fold increased risk, Five-fold increased risk, Ten-fold increased risk, Twenty-fold increased risk, To detect disease recurrence or residual cholesteatoma, To prevent hearing loss progression, To ensure ossicular reconstruction success.
Clinical pearls from this deck
- Painless, chronic, foul-smelling otorrhea is the hallmark that separates cholesteatoma from AOM (where pain dominates). Add granulation tissue and a posterosuperior/pars flaccida perforation — the weakest part of the TM and the classic origin of acquired cholesteatoma — plus conductive loss from ossicular erosion. Any child with chronic painless ear drainage is cholesteatoma until proven otherwise.
- Chronic ET dysfunction leaves the middle ear under negative pressure, which draws the pars flaccida medially into a retraction pocket. Keratin then accumulates faster than it can migrate out, seeding cholesteatoma. (Invasion through a perforation = secondary acquired; embryologic rests = congenital.) Pockets whose base you cannot see need ENT referral.
The ten worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included.
More from this system: all ent decks and question sets · pediatric reference values.
