Complicated course of a post-traumatic cholesteatoma

Post-traumatic cholesteatoma are the result of traumatic displacement of ephitel, for example as a result of skull fractures, explosion trauma or after perforating injuries of the ear canal. They are very rare and only described in individual cases in literature.

A 62-year-old patient was presented to us because of an otalgia with putrid otorrhea that had existed for several weeks and suffered a progredient hearing loss in the past few months. Anamnestically known is a condition after a serious traffic accident with open traumatic brain injury more than 20 years ago. At that time the skull was reconstructed. A year ago a ventricular shunt was placed following intracranial pressure symptoms.

The cCT showed an accumulation of intracerebral air, soft-tissue density opacification of the external auditory canal and mastoid on the right with destruction of the skullbase. The patient was somnolent at the first presentation, but responsive.

Clinically, there was a suspicion of a traumatic cholesteatoma after dislocation of epithelium in the context of the skull base fracture. Based on the intracerebral and ear findings, there was an indication for combined otological-neurosurgical intervention. Intraoperatively, a monstrous cholesteatoma was found, which had led to dural defects in the middle fossa part of the skull. The cholesteatoma was completely removed and the dural defects was covered. In the further course there were no otoliquorrhea or intracranial pressure symptoms.

In individual cases, injuries to the base of the skull can lead to the development of a cholesteatoma due to squamous cell dislocation. For this reason, the cooperation between ENT doctor and neurosurgeon should be standard in difficult cases in order to prevent a serious progress.

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Artikel online veröffentlicht:
24. Mai 2022