A person may develop a cholesteatoma following head trauma with a temporal lobe fracture if the fracture allows stratified squamous epithelium to gain access to certain locations.


Locations where a cholesteatoma may develop:

(1) external auditory canal

(2) middle ear

(3) mastoid air cells

(4) petrous pyramid


Clinical findings:

(1) conductive hearing loss

(2) pain

(3) ear discharge


Associated findings may include:

(1) perilymphatic fistula

(2) persistent CSF leak

(3) infection


Cholesteatomas in the external auditory canal usually present within a few months of the fracture. On the other hand, a cholesteatoma in the middle ear or petrous pyramid may not be detected for many years after the injury.


Any person who has had head trauma with a temporal bone fracture should be followed evidence of cholesteatoma. Head CT scans should be done intermittently as an aid to early diagnosis.


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