Head and Neck Pathology

, Volume 12, Issue 3, pp 419–429 | Cite as

Cholesteatoma Pearls: Practical Points and Update

  • James T. Castle
Special Issue: Ear


The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.


Cholesteatoma Middle ear cholesteatoma Congenital cholesteatoma Acquired cholesteatoma 



Thanks and gratitude to Dr. Robert Shih for his tremendous assistance in radiographic image selection and interpretation and to Drs. Caroline Schlocker and George Conley for their intraoperative images and interpretation.

Compliance with Ethical Standards

Conflict of interest

James T. Castle declares that he has no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2018

Authors and Affiliations

  1. 1.Department of Oral & Maxillofacial Pathology, Naval Postgraduate Dental SchoolNaval Medical Professional Development CenterBethesdaUSA

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