Case contributed by: Kevin C. Pons, M.A., FAAA
ENT Department, Yankton Medical Clinic;
Yankton, SD

The patient is a 41 year old male who experienced acute otalgia, bloody otorrhea and decreased hearing in the RE following an airplane trip. The pain and drainage stopped after a few days but the hearing loss persisted. The patient reported a right temporal bone fracture 20 yrs previously, following a motorcycle accident. Subsequent to the accident, an asymmetrical hearing loss was present and he experienced occasional episodes of bloody otorrhea and disequilibrium.

Physical exam revealed purulent liquid lining the ear canal which was removed along with squamous debris. The middle ear was filled with amber colored fluid and there was a deep retraction pocket in the posterosuperior quadrant of the TM in the area of the scutum. There was granulation tissue and whitish squamous debris extending into the epitympanum to an unknown extent. The cholesteatoma was being partially obscured superficially by a small papilloma.

Acquired Cholesteatoma

The audiogram showed a moderate/severe mixed loss with greatest loss in the highest frequencies. Tympanogram was Type B with symmetrical canal volumes. The SRT was consistent with the audiogram and word recognition was excellent at loud speech volumes.

The patient was treated for the external ear infection, oral antibiotics were prescribed for the middle ear effusion and he was referred to an otolaryngologist in his home state. It was felt that the cholesteatoma may have originated from a longitudinal temporal bone fracture near the TM causing progressive invagination of squamous epithelium resulting in cholesteatoma formation.