Cholesteatoma. The debris,
when removed, exposes a white mass of
epithelium characteristic of a
cholesteatoma. Cholesteatoma
is not a neoplasm; it is simply squamous
epithelium in the middle ear.
If ignored, it increases in size,
becomes infected, and is associated
with a scanty, fetid otorrhea. It may
erode bone, leading to serious complications.
Extension to involve the dura
with intracranial infection may occur,
and the facial nerve and labyrinth too
may be eroded. The extent of the
cholesteatoma determines the danger:
A small attic pocket of epithelium is relatively
harmless, and can be removed
with suction, but an extensive mass of
epithelium is dangerous and needs
exploration and removal via a mastoidectomy
A chronic discharging ear is not
painful, and persistent pain and
headache, or severe vertigo, strongly
suggest an intracranial complication or



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