Skip to main content

Advertisement

SpringerLink
Log in

Nasal sinuses cholesteatoma: case series and review of the English literature

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Nasal sinus cholesteatomas are uncommon slow-growing lesions that are frequently misdiagnosed preoperatively. They can develop due to embryologic remnants or iatrogenic factors (surgical trauma or nasal sinus trauma). In addition, they can cause bone destruction resulting in intracranial or intraorbital complications as well as malignant change if neglected. Complete surgical removal is a must with strict postoperative follow-up.

Materials and methods

Three cases of nasal sinus cholesteatoma are reported. The first case was found inside the ethmoidal sinus, the second in the frontal sinus, and the third was found inside a concha bullosa. In all three cases, a wide endoscopic surgical excision was performed. Due to the lateral extension of the lesion, frontal sinus trephine was also used in the case of frontal sinus nasal cholesteatoma. In addition, a review of the English literature for the reported cases of nasal sinus cholesteatomas was conducted.

Results

There were no reported recurrence or residual during strict postoperative follow-up for 2 years (by endoscopic examination and diffusion-weighted MRI with delayed postcontrast T1 images). A review of the English literature revealed 42 cases of nasal sinuses cholesteatomas (including the present three cases) (17 in the frontal sinus, 15 in the maxillary sinus, 5 in the ethmoid sinus, 3 in the sphenoid sinus, and 2 in a concha bullosa).

Conclusions

Although nasal sinus cholesteatomas are uncommon, they must be considered in the differential diagnosis of slow-growing nasal sinuses lesions. Preoperative CT scan and diffusion-weighted MRI are essential for proper diagnosis and to exclude other similar lesions, such as nasal sinus mucoceles, cholesterol granuloma, or neoplastic lesions. Wide complete surgical excision is necessary to avoid recurrence and facilitate postoperative follow-up. As with ear cholesteatoma, strict postoperative follow-up is required to detect recurrence or residual early and is performed by endoscopic examination, diffusion-weighted MRI, and delayed post-gadolinium T1 images.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Spencer FR (1930) Primary cholesteatoma of the sinuses and orbit: report of a case of many years’ duration followed by carcinoma and death. Arch Otolaryngol 12(1):44–48. https://doi.org/10.1001/archotol.1930.03570010054007

    Article  Google Scholar 

  2. Viswanatha B, Nayak Lk, Karthik S (2007) Cholesteatoma of the maxillary sinus. Ear nose throat J 86(6):351–353 (PMID: 17703815)

    Article  Google Scholar 

  3. Hansen S, Sørensen CH, Stage J, Mouritzen A, Cayé-Thomasen P (2007) Massive cholesteatoma of the frontal sinus: case report and review of the literature. Auris Nasus Larynx 34(3):387–392. https://doi.org/10.1016/j.anl.2006.11.011 (Epub 2007 Feb 2 PMID: 17276024)

    Article  Google Scholar 

  4. Michaels L (1988) Origin of congenital cholesteatoma from a normally occurring epidermoid rest in the developing middle ear. Int J Pediatr Otorhinolaryngol 15(1):51–65. https://doi.org/10.1016/0165-5876(88)90050-x (PMID: 3286554)

    Article  CAS  Google Scholar 

  5. Hopp ML, Montgomery WW (1984) Primary and secondary keratomas of the frontal sinus. Laryngoscope 94(5 pt 1):628–632 (PMID: 6717219)

    CAS  Google Scholar 

  6. Holt GR, Holt JE, Davis WE (1977) Late recurrence of a frontal sinus cholesteatoma. Ann Otol Rhinol Laryngol 86(6 pt 1):852–855. https://doi.org/10.1177/000348947708600623 (PMID: 596787)

    Article  CAS  Google Scholar 

  7. Campanella RS, Caldarelli DD, Friedberg SA (1979) Cholesteatoma of the frontal and ethmoid areas. Ann Otol Rhinol Laryngol 88(4 pt 1):518–523. https://doi.org/10.1177/000348947908800412 (PMID: 475248)

    Article  CAS  Google Scholar 

  8. Hartman JM, Stankiewicz JA (1991) Cholesteatoma of the paranasal sinuses: case report & review of the literature. Ear Nose Throat J 70(10):719–725 (PMID: 1782882)

    CAS  Google Scholar 

  9. Das SK (1971) Cholesteatoma of maxillary sinus. J Laryngol Otol 85(4):397–400. https://doi.org/10.1017/s0022215100073588 (PMID: 5572829)

    Article  CAS  Google Scholar 

  10. Calcaterra TC, Schwartz HE (1976) Cholesteatoma of the frontal sinus. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. 82(5):579–581 (PMID: 1020106)

    CAS  Google Scholar 

  11. Hammami B, Mnejja M, Chakroun A, Achour I, Chakroun A, Charfeddine I, Ghorbel A (2010) Cholesteatoma of the frontal sinus. Eur Ann Otorhinolaryngol Head Neck Dis 127(6):213–216. https://doi.org/10.1016/j.anorl.2010.10.001 (Epub 2010 Nov 10 PMID: 21071299)

    Article  CAS  Google Scholar 

  12. Vaid S, Kamble Y, Vaid N, Bhatti S, Rawat S, Nanivadekar A, Karmarkar S (2013) Role of magnetic resonance imaging in cholesteatoma: the Indian experience. Indian J Otolaryngol Head Neck Surg. 65(Suppl 3):485–492. https://doi.org/10.1007/s12070-011-0360-1 (Epub 2011 Dec 16. PMID: 24427702; PMCID: PMC3889374)

    Article  Google Scholar 

  13. Cukurova I, Demirhan E, Karaman Y, Yigitbasi OG (2009) Extraordinary pathologic entities within the concha bullosa. Saudi Med J 30(7):937–941 (PMID: 19618011)

    Google Scholar 

  14. Chandra RK, Palmer JN (2006) Epidermoids of the paranasal sinuses and beyond: endoscopic management. Am J Rhinol 20(4):441–444. https://doi.org/10.2500/ajr.2006.20.2895 (PMID: 16955776)

    Article  Google Scholar 

  15. Zoia C, Pusateri A, Carena P, Matti E, Galioto S, Benazzo M, Gaetani P, Pagella F (2018) Frontal sinus cholesteatoma with intracranial complication. ANZ J Surg 88(1–2):110–112. https://doi.org/10.1111/ans.13218 (Epub 2015 Jul 14 PMID: 26179883)

    Article  Google Scholar 

  16. Maniglia AJ, Villa L (1977) Epidermoid carcinoma of the frontal sinus secondary to cholesteatoma. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. 84(1):112–115 (PMID: 855080)

    CAS  Google Scholar 

  17. Newman AN, Colman M, Jayich SA (1983) Verrucous carcinoma of the frontal sinus: a case report and review of the literature. J Surg Oncol 24(4):298–303. https://doi.org/10.1002/jso.2930240412 (PMID: 6361388)

    Article  CAS  Google Scholar 

  18. Osborn DA, Wallace M (1967) Carcinoma of the frontal sinus associated with epidermoid cholesteatoma. J Laryngol Otol 81(9):1021–1032. https://doi.org/10.1017/s0022215100067992 (PMID: 6050978)

    Article  CAS  Google Scholar 

  19. Schönauer C, Conrad M, Barbato R, Capuano C, Moraci A (2002) Traumatic rupture into frontal sinus of a frontal intradiploic epidermoid cyst. Acta Neurochir (Wien) 144(4):401–402. https://doi.org/10.1007/s007010200057 (PMID: 12021890)

    Article  Google Scholar 

  20. Lai JC, Liu CK, Chen ML, Chen MK (2010) Removal of frontal sinus keratoma solely via endoscopic sinus surgery. J Laryngol Otol 124(10):1116–1119. https://doi.org/10.1017/S002221511000157X (Epub 2010 Jul 6 PMID: 20602851)

    Article  Google Scholar 

  21. Kurien R, Thomas L, Varghese L, Nair BR (2019) Frontal sinus cholesteatoma: a masquerading diagnosis. BMJ Case Rep 12(11):e231495. https://doi.org/10.1136/bcr-2019-231495 (PMID: 31748359; PMCID: PMC6887418)

    Article  Google Scholar 

  22. Tejani N, Kshirsagar R, Song B, Liang J (2020) Evolving treatment of frontal sinus cholesteatoma: a case report. Perm J. 24:19.048. https://doi.org/10.7812/TPP/19.048 (Epub 2020 Feb 14. PMID: 32097113; PMCID: PMC7039422)

    Article  Google Scholar 

  23. Cingi E, Cingi C (1991) Ethmoidal cholesteatoma. Ann Otol Rhinol Laryngol 100(5 Pt 1):424–426. https://doi.org/10.1177/000348949110000514 (PMID: 2024902)

    Article  CAS  Google Scholar 

  24. Barnett FC, Barnett JC Jr (1992) Massive bifrontal epidermoid tumor. Surg Neurol 38(6):437–440. https://doi.org/10.1016/0090-3019(92)90112-z (PMID: 1298109)

    Article  CAS  Google Scholar 

  25. Pogorel BS, Budd EG (1965) Cholesteatoma of the maxillary sinus; a case report. Arch Otolaryngol 82(5):532–534. https://doi.org/10.1001/archotol.1965.00760010534016 (PMID: 5844992)

    Article  CAS  Google Scholar 

  26. Mills CP, Sycamore EM (1958) Cholesteatoma of the maxillary antrum. J Laryngol Otol 72(7):580–583. https://doi.org/10.1017/s0022215100054347 (PMID: 13564028)

    Article  CAS  Google Scholar 

  27. Baxter JS (1966) Cholesteatoma of the maxillary antrum. J Laryngol Otol 80(10):1059–1061. https://doi.org/10.1017/s002221510006638x (PMID: 5957787)

    Article  CAS  Google Scholar 

  28. Paaske PB (1984) Cholesteatoma of the maxillary sinus (a case report). J Laryngol Otol 98(5):539–541. https://doi.org/10.1017/s0022215100147048 (PMID: 6715988)

    Article  CAS  Google Scholar 

  29. Sadoff RS, Pliskin A (1989) Cholesteatoma (keratoma) of the maxillary sinus: report of a case. J Oral Maxillofac Surg 47(8):873–876. https://doi.org/10.1016/s0278-2391(89)80052-7 (PMID: 2746397)

    Article  CAS  Google Scholar 

  30. Storper IS, Newman AN (1992) Cholesteatoma of the maxillary sinus. Arch Otolaryngol Head Neck Surg 118(9):975–977. https://doi.org/10.1001/archotol.1992.01880090091023 (PMID: 1503726)

    Article  CAS  Google Scholar 

  31. Vaz F, Callanan V, Leighton S, Risdon RA (2000) Congenital maxillary sinus cholesteatoma. Int J Pediatr Otorhinolaryngol 52(3):283–286. https://doi.org/10.1016/s0165-5876(00)00289-5 (PMID: 10841959)

    Article  CAS  Google Scholar 

  32. Palacios E, Robertson H (2005) Cholesteatoma of the maxillary sinus. Ear Nose Throat J 84(12):758. https://doi.org/10.1177/014556130508401205 (PMID: 16408548)

    Article  Google Scholar 

  33. Viswanatha B (2011) Cholesteatoma of the nose and maxillary and ethmoid sinuses: a rare complication of palatal surgery. Ear Nose Throat J 90(9):428–430. https://doi.org/10.1177/014556131109000909 (PMID: 21938702)

    Article  Google Scholar 

  34. Buric N, Jovanovic G, Tijanic M (2013) Usefulness of cone-beam CT for presurgical assessment of keratoma (cholesteatoma) of the maxillary sinus. Head Neck 35(7):E221–E225. https://doi.org/10.1002/hed.23031 (Epub 2012 Jun 19 PMID: 22714837)

    Article  Google Scholar 

  35. Sozansky J, Josephson JS (2015) Cholesteatoma of the maxillary sinus: a case report and review of the literature. Am J Otolaryngol 36(2):290–291. https://doi.org/10.1016/j.amjoto.2014.10.025 (Epub 2014 Oct 18. PMID: 25459312)

    Article  Google Scholar 

  36. Jin H, Shin JH, Kim KS (2016) Cholesteatoma of maxillary sinus: what is the best surgical approach? J Craniofac Surg 27(4):963–966. https://doi.org/10.1097/SCS.0000000000002609 (PMID: 27171957)

    Article  Google Scholar 

  37. Vakalapudi S, Majumdar S, Uppala D (2021) Cholesteatoma of maxillary sinus simulating neoplasia: a rare case report. Int J Appl Basic Med Res 11(1):56–59. https://doi.org/10.4103/ijabmr.IJABMR_374_20 (Epub 2021 Jan 26. PMID: 33842300; PMCID: PMC8025957)

    Article  Google Scholar 

  38. Ohta S, Nishizawa S, Ryu H, Yokoyama T, Hinokuma K, Yamaguchi M, Uemura K (1997) Epidermoid tumor in the sphenoid sinus–case report. Neurol Med Chir (Tokyo) 37(4):350–353. https://doi.org/10.2176/nmc.37.350 (PMID: 9136562)

    Article  CAS  Google Scholar 

  39. Sani S, Smith A, Leppla DC, Ilangovan S, Glick R (2005) Epidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report. Surg Neurol 63(4):394–397. https://doi.org/10.1016/j.surneu.2004.02.039 (discussion 397. PMID: 15808736)

    Article  Google Scholar 

  40. Kanjanawasee D, Chaowanapanja P, Keelawat S, Snidvongs K (2019) Sphenoid sinus cholesteatoma-complications and skull base osteomyelitis: case report and review of literature. Clin Med Insights Case Rep 5(12):1179547619835182. https://doi.org/10.1177/1179547619835182 (PMID: 30858746; PMCID: PMC6402053)

    Article  Google Scholar 

  41. Cukurova I, Demirhan E, Arslan IB, Cumurcu S (2010) Cholesteatoma of the concha bullosa: a case report. J Med Case Rep 17(4):407. https://doi.org/10.1186/1752-1947-4-407 (PMID: 21167029; PMCID: PMC3012043)

    Article  Google Scholar 

  42. Yağci AB, Kara CO, Karabulut N et al (2003) Horseshoe maxillary sinus: CT of a unique case with cholesteatoma. Eur J Radiol Extra 48(1):5–7. https://doi.org/10.1016/S1571-4675(03)00078-6

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, 11331, Egypt

    Ahmed Nabil Abdelhamid Ahmed, Mohamed M. Elsharnouby & Marwa Mohamed Elbegermy

Authors
  1. Ahmed Nabil Abdelhamid Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed M. Elsharnouby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marwa Mohamed Elbegermy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed Nabil Abdelhamid Ahmed.

Ethics declarations

Conflicts of interest

No conflicts of interest.

Ethical considerations

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and the national research committee and with the 1964 Helsinki declaration and its later amendments.

Consent

A preoperative informed written consent has been obtained from all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, A.N.A., Elsharnouby, M.M. & Elbegermy, M.M. Nasal sinuses cholesteatoma: case series and review of the English literature. Eur Arch Otorhinolaryngol 280, 743–756 (2023). https://doi.org/10.1007/s00405-022-07564-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07564-8

Keywords

Search

Navigation