Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking to you about Cholestiatomas. And you can find written notes on this topic at

zero definals.com slash calestiaatoma or in the ear, nose and throat section of the zero definals surgery book. So let's get

straight into it. A cholesterol tomar is an abnormal collection of squamous epithelial cells in the middle

ear. It's non-cancerous, but it can invade local tissues and nerves and it can

erode the bones of the middle ear. It can also predispose to significant infections. Confusingly,

colestiotoma has nothing to do with cholesterol or a tumour. Let's talk about the pathophysiology.

The pathophysiology of cholesterolomas is not fully understood.

Squamous epithelial cells originate from the outer surface of the tympanic membrane.

The main theory is that negative pressure in the middle ear, caused by eustacean tube dysfunction, causes a pocket of the tympanic membrane to retract into the middle ear.

Essentially, a small area of the tympanic membrane gets sucked inwards.

The squamous epithelial cells of this pocket continue to proliferate and grow into the surrounding

space, the bones and the tissues. The colestiotoma can damage the ossicles, which are the tiny

bones of the middle ear that are involved in hearing, and this results in permanent hearing loss.

The osicles conduct the sound from the tympanic membrane to the inner ear,

therefore the hearing loss is conductive as opposed to sensory neural.

Let's talk about the presentation.

There are two typical presenting symptoms to remember, and these are

a foul discharge from the ear and unilateral conductive hearing loss. As the cholesterol

telestiaoma continues to expand into the surrounding spaces and tissues, further symptoms may

develop, which include infection, pain,

vertigo and facial nerve palsy. Autoscopy, where an otoscope is used to look down the ear

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