How is a cholesteatoma diagnosed?
The GP or ear specialist (ENT doctor) may suspect cholesteatoma based on the typical symptoms. When the ear is examined with a torch (an otoscope), the cholesteatoma may be seen. Often there is a hole (perforation) in the eardrum (the tympanic membrane) too.
Because the symptoms come on slowly and mimic common ear infections, the diagnosis is often delayed.
- It is very difficult for a GP to see a cholesteatoma because usually it causes a lot of pus in the ear which blocks the view to the eardrum.
- For this reason the diagnosis is made by an ear specialist at a hospital.
- The ear specialist will use a tiny suction tube to suck away the discharge and look at the eardrum in detail with a microscope that magnifies the view.
- By looking in detail, close up, at the eardrum, a specialist can see the cholesteatoma pushing through the eardrum.
- To then see how far it has spread inside the ear, a specialist scan is needed: this is usually a CT scan (which takes about 30 seconds) or an MRI scan (which can take about half an hour).
What does a cholesteatoma look like?
In the image below, the white arrow on the left shows a cholesteatoma. The white tube underneath is a grommet that was put in to try to help the middle ear. The picture on the right shows what the surgeon has removed: a pale, greasy mass of cholesteatoma. It is just a few millimetres in size.
Do I need any further tests?
Hearing tests (audiometry) may show deafness or hearing loss and are usually performed in a hospital clinic. Samples (swabs) of the ear discharge may also be taken. The discharge often contains a germ (bacterium) called Pseudomonas which is responsible for the smell. A CT scan might be needed to see the extent of the damage caused by the cholesteatoma, and to plan further treatment.
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