Cholesteatoma

A 35-year-old man presents with chronic ear discharge and conductive hearing loss. Otoscopy reveals a retraction pocket in the posterosuperior quadrant of the tympanic membrane. CT temporal bone shows an expansile lesion eroding the ossicles and lateral semicircular canal. Regarding the pathophysiology and clinical features of cholesteatoma, all of the following are true EXCEPT:

A 28-year-old woman with a 10-year history of chronic suppurative otitis media undergoes high-resolution CT temporal bone for preoperative planning. The scan shows ossicular erosion, lateral semicircular canal fistula, and sinus tympani involvement. Regarding the diagnostic features and complications of cholesteatoma, all of the following are correct EXCEPT:

A 38-year-old man from rural India presents with a 6-month history of foul-smelling otorrhoea from the left ear and progressive conductive hearing loss. Otoscopy reveals a retraction pocket in the posterosuperior quadrant with granulation tissue. High-resolution CT temporal bone shows erosion of the scutum and ossicular chain involvement. What is the most appropriate next step in management?

A 28-year-old woman undergoes canal wall up (CWU) mastoidectomy for attic cholesteatoma. At 18 months post-operatively, she presents with recurrent foul-smelling ear discharge and audiometry shows new sensorineural hearing loss in the high frequencies. CT temporal bone shows small residual disease in the sinus tympani. What is the most appropriate next step in management?

A 28-year-old man from rural Rajasthan presents with a 6-month history of foul-smelling otorrhoea from the left ear following a head injury. On otoscopy, there is a perforation in the postero-superior quadrant of the tympanic membrane with granulation tissue visible. Pure tone audiometry shows conductive hearing loss. High-resolution CT temporal bone reveals a soft-tissue density in the epitympanic recess with erosion of the ossicles and lateral semicircular canal. What is the most likely diagnosis?