Thanks for another banger video, Doc! Question: how can you differentiate cholesteotoma from severe acute otomastoiditis? They both can have middle ear opacification, ossicle destruction, and diffusion restriction
Hello and thank you for the interesting question. I've never personally been confronted with a similar dilemma on imaging, and i believe that's mainly due to the huge difference in clinical presentation (pretest probability plays a big role in my differential diagnostic reasoning). In acute otomastoditis we're dealing with a patient with an acute presentation (fever, ear pain, redness, maybe complications, purulent discharge....) while our cholesteatoma patient has chronic discharge and/or conduction hearing loss as main complaints. Furtheremore, I haven't seen that many ossicular destruction in otomastodiits (personal experience, don't have statistics). In chronic OME we can see some ossicular lysis, but especially of the lenticular process of the incus (typical location), this in contrast to the erosions that are observed in cholesteatoma and are (in your typical pars flaccida cholesteatoma) located mainly in the malleus head and incus corpus. In the end it's combining all elements off course, but I believe in this DDx clinical presentation plays a very important role.
Perfect overview on the diagnosis of cholesteatomas. Thanks a lot!
Thank you sir
Thanks for another banger video, Doc! Question: how can you differentiate cholesteotoma from severe acute otomastoiditis? They both can have middle ear opacification, ossicle destruction, and diffusion restriction
Hello and thank you for the interesting question. I've never personally been confronted with a similar dilemma on imaging, and i believe that's mainly due to the huge difference in clinical presentation (pretest probability plays a big role in my differential diagnostic reasoning).
In acute otomastoditis we're dealing with a patient with an acute presentation (fever, ear pain, redness, maybe complications, purulent discharge....) while our cholesteatoma patient has chronic discharge and/or conduction hearing loss as main complaints.
Furtheremore, I haven't seen that many ossicular destruction in otomastodiits (personal experience, don't have statistics). In chronic OME we can see some ossicular lysis, but especially of the lenticular process of the incus (typical location), this in contrast to the erosions that are observed in cholesteatoma and are (in your typical pars flaccida cholesteatoma) located mainly in the malleus head and incus corpus.
In the end it's combining all elements off course, but I believe in this DDx clinical presentation plays a very important role.
Thank you
Thank you