Cholesteatoma Differential Diagnoses

Updated: Apr 12, 2022
  • Author: Vijay A Patel, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Diagnostic Considerations

The diagnosis may be in doubt in individuals with small epitympanic retractions observed during physical examination. Computed tomography (CT) scanning may help to distinguish between shallow retractions without soft tissue extension into the epitympanic space and an extensive soft tissue mass with bony erosion.

CT scanning can also be helpful in individuals who previously had otologic surgery. In this group of patients, a white mass behind the tympanic membrane (shown below) may represent tympanosclerosis, cartilage grafting, or recurrent cholesteatoma. CT scanning may frequently help to resolve such questions. Diffusion-weighted magnetic resonance imaging (MRI) may also be helpful in these circumstances.

A large cholesteatoma. No landmarks are visible, w A large cholesteatoma. No landmarks are visible, which typically is the case with advanced cholesteatomas.

Other otologic conditions that should be considered include:

  • Middle ear osteoma
  • Granulomatous disease (eg, granulomatosis with polyangiitis [Wegener granulomatosis], histiocytosis X)
  • Mycobacterial infection
  • Primary auricular and/or temporal bone malignancy

Differential Diagnoses