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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